Traztuzumab (Herceptin) Information for patients Chemotherapy Name Hospital No Your consultant is Important Advice Always carry your chemotherapy alert card. It is important that you know what to do if you feel ill at home. If you have had treatment within the last 6 weeks and think you have developed symptoms of infection or you have any unusual bruising or bleeding (for example heavy nosebleed), it is essential to phone Weston Park Hospital for urgent medical help. Symptoms of infection include: sore throat temperature above 37.5 C shivering cough or cold symptoms diarrhoea feeling unwell even with a normal temperature People undertaking Chemotherapy may become poorly very quickly. This can become life-threatening, particularly if warning signs are ignored. Weston Park Hospital contact number - 0114 226 5000 Ask the switchboard operator to put you through to the assessment unit nurse at Weston Park Hospital. Even if you have part of your treatment at Chesterfield and North Derbyshire Royal Hospital, Rotherham District General Hospital, Doncaster Royal Infirmary or Barnsley District General Hospital, you should still phone Weston Park Hospital. If you are ever admitted to hospital, attend Accident and Emergency or consult any Doctor, you must tell the Doctor that you are receiving anticancer treatment. You should ideally take this information sheet with you. They should then contact Weston Park Hospital for advice. PD7558-PIL3099 v3 Issue Date: March 2018. Review Date: March 2021
What is my treatment? Herceptin is one of a group of cancer drugs called monoclonal antibodies. It works by blocking the action of proteins that help the cancer cell to divide and grow. Some cancers have too much of a protein called human epidermal growth factor receptor 2 (HER2) on the surface of their cells. It can be helpful to think of these receptors as a switch. When the switch is in the on position it helps the cancer cells to divide and grow. Herceptin attaches to the HER2 protein. This blocks the receptor and stops the cancer cells from dividing. Herceptin only works in people who have cancer with high levels of the HER2 protein. Monoclonal antibodies are part of a group of treatments called anti-cancer therapy. They can be given on their own or with other treatments, including chemotherapy. The possible benefits of treatment can vary from patient to patient. For some patients it can reduce the risk of the cancer coming back. For others it may be used to control the cancer and its symptoms. Your treatment will be fully explained by your doctor who will be happy to answer any questions, including any other possible ways of treating your particular cancer. Please feel free to ask what other treatments are available and any other questions you have about treatment. How is Herceptin given? Herceptin can be given as an intravenous drip into the vein. This is called an intravenous infusion. The first infusion will take 90 minutes as it is a larger loading dose. If there are no problems future treatments can be given over 30 minutes. Herceptin can also be given as an injection under the skin of your thigh over 2-5 minutes. This is called subcutaneous. Your doctor will discuss with you how you are to have your treatment. Some patients will have an intravenous infusion when they start their course of treatment. They may then switch to having the injection under the skin. It is important to know that the infusion and the injection will give you the same drug and work in the same way. They have the same effect on the cancer cells and similar side effects. After being given Herceptin you will need to be observed to check you don t have any immediate treatment-related symptoms. At your first treatment you will need to be observed for 6 hours from the time the infusion is started or 2 hours after the injection under the skin is given. If you have no problems then the observation time will be much less for future Herceptin treatments. This is the same if you have the intravenous infusion or the injection under the skin. Herceptin can be given every week or every 3 weeks. Your doctors will discuss with you how often you will have your treatment. Will I see my doctor regularly? Before each of your treatments you will see a doctor or a specially trained nurse or pharmacist who will make sure it is safe for you to have your chemotherapy. It is very important that you tell them how you are feeling and about any side effects you have had since your last treatment. page 2 of 5
Tell your doctor, before starting treatment Please tell your doctor about all of the medicines you are currently taking, including those bought from a pharmacy and vitamins/supplements or herbal medicines. Herceptin can affect the safety of other medicines. Other medicines may affect Herceptin. Also tell your doctor about any of the following: If you have been told you have heart disease If you have ever had lung disease (e.g. asthma, bronchitis), breathing problems or need oxygen If you have any allergies If you are pregnant or breast feeding or trying to conceive a child Are there any side effects or risks to having treatment? As part of consenting to have the treatment, your consultant team will discuss the risks and side effects of the drugs you will be given. Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here won't affect everyone who is given this treatment, and may be different if you are having more than one chemotherapy drug. We have outlined the most common side effects and some general advice. We have included some of the less common side effects. We haven't included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which aren't listed in this information, please discuss them with your doctor, chemotherapy nurse or pharmacist. The side effects of Herceptin fall into two groups: infusion-related side effects, which occur while you re receiving the treatment (during the infusion) or within about four hours of it being given. These side effects are usually most noticeable with the first dose and less noticeable with following doses. later side effects, which may occur a few days or weeks after treatment. Infusion-related side effects Flu-like symptoms These may include a headache, a high temperature (fever) and chills, feeling sick (nausea) or being sick (vomiting). These symptoms can be controlled or reduced with medicines, which your doctor can prescribe for you. They generally get better within a few hours of the infusion finishing. Allergic reaction This is uncommon. Signs may include a skin rash, itching, wheezing, difficulty breathing and breathlessness. You'll be closely monitored during your treatment, but let your nurse or doctor know if you have any of these symptoms. Medicines called antihistamines can be given before the infusion to reduce the chance of you having an allergic reaction. page 3 of 5
Later side effects Feeling sick (nausea) and being sick (vomiting) This is usually mild and doesn t last for very long. It can be managed by anti-sickness medication. Contact Weston Park Hospital for advice if you feel or are sick. If you vomit more than once in 24 hours or your eating and drinking has been badly affected because you feel sick, phone Weston Park Hospital. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem. Diarrhoea may be a problem. If you experience diarrhoea you should contact Weston Park Hospital for advice. It is important that you drink plenty to avoid dehydration. If it does not settle then you may need to be admitted for extra fluids to be given through a vein. Diarrhoea might also be a sign of infection. It is essential to take your temperature and contact Weston Park Hospital for advice if you have a temperature above 37.5ºC or you feel unwell. Effects on the heart Herceptin may affect the way your heart works. Therefore, it is not recommended for people with a history of heart disease or high blood pressure. You will have tests to check your normal heart function before starting treatment with Herceptin, and at regular intervals during treatment. You should contact Weston Park Hospital if you develop any symptoms of heart problems. These include breathlessness (including breathlessness at night) or swollen ankles, legs or arms. Tiredness (fatigue) and feeling weak You may feel tired during and after your treatment. It s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don t drive or operate machinery. Effects on the respiratory (lung) system Herceptin can cause problems with the respiratory system such as fluid in the lungs, pneumonia and inflammation of the lung tissue. This is not common. Contact Weston Park Hospital if you have any problems with breathing. Other side effects include: Headache Dizziness Joint pain Rash Additional information Risk of blood clots - Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information. page 4 of 5
Pregnancy and contraception pregnancy must be avoided whilst on Herceptin as the developing foetus may be harmed. It is necessary to use effective contraception while taking this drug, and for at least seven months afterwards. It is also advisable to use a barrier method of contraception, for example condoms, whilst you are having anticancer therapy as the drugs may be secreted through bodily fluids. Again, discuss this with your doctor. An information leaflet is available: please ask your nurse for this. Alcohol - Drink only in moderation (1-2 units per day); note that certain medications you are taking may be affected by alcohol. One unit means half a pint of normal strength lager, small glass of wine or a single measure of spirits. Dental advice - Please tell your dentist that you are receiving anticancer therapy before you have any treatment, including scale and polish, because you are at a greater risk of having bleeding gums, or developing a mouth infection. It is advisable that you have a blood test before any emergency dental treatment. Flu jabs - If you choose to have a flu injection, this should be given before commencing chemotherapy. If you are already on treatment, you can have the injection one or two days before your next cycle starts. You may not develop a full immune response to the vaccine if you have it while you are on treatment. Live vaccines must not be given to patients receiving chemotherapy, this includes the nasal spray flu vaccine and the shingles vaccine (Varicella Zoster). Sources of further information Further information is available from: Weston Park Cancer Information and Support Centre 23 Northumberland Road Sheffield S10 2TX Website: www.cancersupportcentre.co.uk Email: info@cancersupportcentre.co.uk Tel: 0114 226 5666 Produced with support from Sheffield Hospitals Charity working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD7558-PIL3099 v3 Issue Date: March 2018. Review Date: March 2021