TRASTUZUMAB

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

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 

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.

  • 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.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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