TRASTUZUMAB (tra-stu'zu-mab)
Herceptin Classifications: immunomodulator; monoclonal antibody; antineoplastic; anti-human epidermal growth factor (anti-her); Therapeutic: antineoplastic; immunomodulator; anti-her Pregnancy Category: B
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Availability
21 mg/mL injection
Action
Recombinant DNA monoclonal antibody (IgG1 kappa) that selectively binds to the human epidermal growth factor receptor-2 protein (HER2).
Therapeutic Effect
Inhibits growth of human tumor cells that overexpress HER2 proteins.
Uses
Metastatic breast cancer in those whose tumors overexpress the HER2 protein. HER2-positive breast cancer after surgery.
Contraindications
Concurrent administration of anthracycline or radiation; lactation during and for 6 mo following administration of trastuzumab.
Cautious Use
Preexisting cardiac dysfunction; pulmonary disease; previous administration of cardiotoxic therapy (e.g., anthracycline
or radiation); pregnancy (category B); older adults; hypersensitivity to benzyl alcohol (preservative in bacteriostatic water).
Route & Dosage
Metastatic Breast Cancer Adult: IV 4 mg/kg, then 2 mg/kg qwk
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Administration
Intravenous PREPARE: IV Infusion: Reconstitute each vial with 20 mL of supplied diluent (bacteriostatic water) to produce a multidose vial containing 21 mg/mL.
Note: For patients with a hypersensitivity to benzyl alcohol, reconstitute with sterile water for injection; this solution
must be used immediately with any unused portion discarded. Withdraw the ordered dose and add to a 250 mL of NS and invert
bag to mix. Do not give or mix with dextrose solutions.
ADMINISTER: IV Infusion: Infuse loading dose (4 mg/kg) over 90 min; infuse subsequent doses (2 mg/kg) over 30 min. Do not give IV push or as a bolus
dose.
INCOMPATIBILITIES Solution/additive: Dextrose solution; do not mix or coadminister with other drugs.
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- Store unopened vials and reconstituted vials at 2°8° C (36°46° F). Discard reconstituted
vials 28 days after reconstitution.
Adverse Effects (≥1%)
Body as a Whole: Pain, asthenia, fever, chills, flu
syndrome, allergic reaction, bone pain,
arthralgia,
hypersensitivity (anaphylaxis, urticaria, bronchospasm, angioedema, or hypotension), increased
incidence of infections, infusion reaction (
chills, fever, nausea, vomiting, pain, rigors, headache, dizziness,
dyspnea, hypotension, rash).
CNS: Headache, insomnia, dizziness, paresthesias, depression, peripheral
neuritis,
neuropathy.
CV: CHF, cardiac dysfunction (dyspnea, cough, paroxysmal nocturnal
dyspnea, peripheral edema, S3 gallop, reduced ejection fraction),
tachycardia, edema, cardiotoxicity.
GI: Diarrhea, abdominal pain, nausea, vomiting, anorexia.
Hematologic: Anemia, leukopenia. Respiratory: Cough, dyspnea, rhinitis, pharyngitis,
sinusitis.
Skin: Rash, herpes simplex,
acne.
Interactions
Drug: Paclitaxel may increase trastuzumab levels and
toxicity.
Pharmacokinetics
Half-Life: 5.8 d.
Nursing Implications
Assessment & Drug Effects
- Lab tests: Periodically monitor CBC with differential, platelet count, and Hgb and Hct.
- Monitor for chills and fever during the first IV infusion; these adverse events usually respond to prompt treatment without
the need to discontinue the infusion. Notify physician immediately.
- Monitor carefully cardiovascular status at baseline and throughout course of therapy, assessing for S&S of heart failure
(e.g., dyspnea, increased cough, PND, edema, S3 gallop). Those with preexisting cardiac dysfunction are at high risk for
cardiotoxicity.
Patient & Family Education
- Report promptly any unusual symptoms (e.g., chills, nausea, fever) during infusion.
- Report promptly any of the following: Shortness of breath, swelling of feet or legs, persistent cough, difficulty sleeping,
loss of appetite, abdominal bloating.