What is Herceptin?

Herceptin is a cancer medicine that interferes with the growth and spread of cancer cells in the body. Herceptin is used to treat certain types of breast cancer or stomach cancer. Other cancer medicines are sometimes used in combination with Herceptin.

Herceptin is sometimes used when the cancer has spread to other parts of the body (metastatic).

Warnings

Do not use Herceptin if you are pregnant. It could harm the unborn baby. Avoid becoming pregnant for at least 7 months after your last dose of trastuzumab. Use effective birth control, and tell your doctor if you become pregnant during treatment.

Herceptin can cause heart failure, especially if you have heart disease or if you are also receiving certain other cancer medicines.

Some side effects may occur during the injection. Tell your caregivers if you feel dizzy, nauseated, light-headed, weak, short of breath, or if you have a headache, fever, or chills.

Before taking this medicine

You should not be treated with Herceptin if you are allergic to trastuzumab.

To make sure Herceptin is safe for you, tell your doctor if you have ever had:

• heart disease;
• congestive heart failure;
• a heart attack; or
• any allergies or breathing problems.

Trastuzumab can cause heart failure, especially if you have heart disease or if you are also receiving certain other cancer medicines (such as daunorubicin, doxorubicin, epirubicin, or idarubicin).

You may need to have a negative pregnancy test before starting this treatment.

Do not use Herceptin if you are pregnant. This medicine can cause injury or death to the unborn baby. Use effective birth control to prevent pregnancy while you are using this medicine and for at least 7 months after your last dose. Tell your doctor if you become pregnant during treatment.

If you become pregnant while using this medicine or within 7 months after you stop, your name may be listed on a pregnancy registry to track the effects of trastuzumab on the baby.

It may not be safe to breastfeed while using this medicine and for up to 7 months after your last dose. Ask your doctor about any risk.

How is Herceptin given?

Herceptin is given as an infusion into a vein. A healthcare provider will give you this injection.

Herceptin is usually given once every week or every 1 to 3 weeks. Follow your doctor’s dosing instructions very carefully.

Your doctor will perform a medical test to make sure trastuzumab is the right medicine to treat your cancer.

This medicine must be given slowly, and the infusion can take up to 90 minutes to complete.

You may need frequent medical tests to be sure this medicine is not causing harmful effects. Your cancer treatments may be delayed based on the results.

Your heart function may need to be checked before and during treatment with trastuzumab. You may also need heart function testing every 6 months for 2 years after your last dose of this medicine.

Herceptin is usually given for 52 weeks, or until your body no longer responds to the medication.

Dosing information

Usual Adult Dose of Herceptin for Breast Cancer:

For use in the treatment of metastatic breast cancer:
Administer trastuzumab, alone or in combination with paclitaxel.
Initial dose: 4 mg/kg IV infusion over 90 minutes
Subsequent therapy: 2 mg/kg IV infusion over 30 minutes once weekly until disease progression

Usual Adult Dose of Herceptin for Breast Cancer — Adjuvant:

Administer according to one of the following doses and schedules:

1) Initiate trastuzumab during and following paclitaxel, docetaxel, or docetaxel/carboplatin:
Initial dose: 4 mg/kg IV infusion over 90 minutes then 2 mg/kg IV infusion over 30 minutes weekly during chemotherapy for the first 12 weeks (paclitaxel or docetaxel) or 18 weeks (docetaxel/carboplatin).
Subsequent therapy: one week after the last weekly dose of trastuzumab, give trastuzumab as 6 mg/kg IV infusion over 30 to 90 minutes every 3 weeks for a total of 52 weeks of therapy.
or
2) Initiate trastuzumab as a single agent within 3 weeks following completion of all chemotherapy.
Initial dose: 8 mg/kg IV infusion over 90 minutes
Subsequent therapy: 6 mg/kg IV infusion over 30 to 90 minutes every 3 weeks for a total of 17 doses (52 weeks of therapy)

Usual Adult Dose of Herceptin for Esophageal Carcinoma:

For use in the treatment of metastatic gastric or gastroesophageal junction adenocarcinoma:
Administer trastuzumab in combination with cisplatin and capecitabine or 5-fluorouracil.
Initial dose: 8 mg/kg IV infusion over 90 minutes
Subsequent therapy: 6 mg/kg IV infusion over 30 to 90 minutes every 3 weeks until disease progression

Usual Adult Dose of Herceptin for Gastric Cancer:

For use in the treatment of metastatic gastric or gastroesophageal junction adenocarcinoma:
Administer trastuzumab in combination with cisplatin and capecitabine or 5-fluorouracil.
Initial dose: 8 mg/kg IV infusion over 90 minutes
Subsequent therapy: 6 mg/kg IV infusion over 30 to 90 minutes every 3 weeks until disease progression

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your trastuzumab injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while receiving Herceptin?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

Herceptin side effects

Get emergency medical help if you have signs of an allergic reaction to Herceptin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Some side effects may occur during the injection, or in the days afterward. Tell your caregiver right away if you feel dizzy, nauseated, itchy, light-headed, weak, short of breath, or if you have a headache, fever, chills, or chest pain.

Call your doctor at once if you have:

• new or worsening cough;
• a light-headed feeling, like you might pass out;
• severe headache, blurred vision, pounding in your neck or ears;
• blisters or ulcers in your mouth, red or swollen gums, trouble swallowing;
• heart problems – pounding heartbeats, dizziness, swelling in your lower legs, rapid weight gain, feeling short of breath;
• low blood cell counts – fever, chills, tiredness, skin sores, easy bruising, unusual bleeding, pale skin, cold hands and feet, feeling light-headed; or
• signs of tumor cell breakdown – tiredness, weakness, muscle cramps, nausea, vomiting, diarrhea, fast or slow heart rate, decreased urination, tingling in your hands and feet or around your mouth.

Your cancer treatments may be delayed or permanently discontinued if you have certain side effects.

Common Herceptin side effects may include:

• heart problems;
• nausea, diarrhea, weight loss;
• headache;
• trouble sleeping, feeling tired;
• low blood cell counts;
• rash;
• fever, chills, cough, or other signs of infection;
• mouth sores;
• altered sense of taste; or
• cold symptoms such as stuffy nose, sinus pain, sore throat.

What is Kadcyla?

Kadcyla is a cancer medicine that interferes with the growth and spread of cancer cells in the body.

Kadcyla is used to treat HER2-positive breast cancer.

Kadcyla is used both for early breast cancer and for breast cancer that has spread to other parts of the body (metastatic).

Kadcyla is usually given after other cancer medications have been tried without success.

Kadcyla should not be used in place of Herceptin (trastuzumab).

Warnings

Do not use Kadcyla if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment.

You may need to have a negative pregnancy test before starting this treatment.

Kadcyla can harm your liver. Call your doctor at once if you have upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes).

Before you receive each Kadcyla injection, your heart function may need to be checked using an electrocardiograph or ECG (sometimes called an EKG).

Before taking this medicine

You should not use Kadcyla if you are allergic to ado-trastuzumab emtansine.

Do not use Kadcyla if you are pregnant. It could harm the unborn baby or cause birth defects. Use effective birth control to prevent pregnancy while you are using this medicine and for at least 7 months after your last dose.

Tell your doctor if you become pregnant during treatment.

To make sure Kadcyla is safe for you, tell your doctor if you have ever had:

• heart problems;
• liver disease (especially hepatitis B or C);
• bleeding or blood clotting disorder such as hemophilia; or
• asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder.

You should not breast-feed while using this medicine.

How is Kadcyla given?

Kadcyla is given as an infusion into a vein. A healthcare provider will give you this injection.

This medicine must be given slowly, and the infusion can take 30 to 90 minutes to complete.

Tell your caregivers if you feel any burning, pain, or swelling around the IV needle when Kadcyla is injected.

Kadcyla is usually given once every 3 weeks. Your doctor will determine how long to treat you.

You may need frequent medical tests to be sure this medicine is not causing harmful effects. Your cancer treatments may be delayed based on the results.

Dosing information

Usual Adult Dose for Breast Cancer:

3.6 mg/kg IV every 3 weeks (21-day cycle) until disease progression or unacceptable toxicity
Maximum dose: 3.6 mg/kg IV every 3 weeks

Comments:
-Administer the first infusion over 90 minutes. Subsequent infusions may be administered over 30 minutes as tolerated.
-Observe patients during and for at least 90 minutes following the initial dose for fever, chills, or other infusion-related reactions.
-Patients should have a HER2 positive tumor status confirmed prior to starting therapy.
-Do not substitute trastuzumab emtansine for or with trastuzumab.
-If a planned dose is delayed or missed, it should be administered as soon as possible; do not wait until the next planned cycle.

Use: As a single agent, for HER2-positive, metastatic breast cancer in patients who previously received trastuzumab and a taxane, separately or in combination; patients should have either:
-Received prior therapy for metastatic disease
OR
-Developed disease recurrence during or within 6 months of completing adjuvant therapy

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your Kadcyla injection.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What to avoid

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Ado-trastuzumab emtansine can pass into body fluids (urine, feces, vomit). For at least 48 hours after you receive a dose, avoid allowing your body fluids to come into contact with your hands or other surfaces. Caregivers should wear rubber gloves while cleaning up a patient’s body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Kadcyla side effects

Get emergency medical help if you have signs of an allergic reaction to Kadcyla: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Some side effects may occur during the injection. Tell your caregiver right away if you feel cold, light-headed, feverish or sweaty, or have chest tightness, rapid heartbeats, or trouble breathing.

Call your doctor at once if you have:

• easy bruising, unusual bleeding, purple or red spots under your skin;
• coughing up blood or vomit that looks like coffee grounds;
• bloody or tarry stools;
• chest pain, wheezing, dry cough, feeling short of breath;
• unusual tiredness, feeling light-headed;
• pale skin, cold hands and feet;
• numbness, tingling, or burning pain in your hands or feet;
• sudden numbness or weakness (especially on one side of the body), severe headache, slurred speech, balance problems;
• liver problems – loss of appetite, stomach pain (upper right side), dark urine, jaundice (yellowing of the skin or eyes); or
• signs of tumor cell breakdown – confusion, weakness, muscle cramps, nausea, vomiting, fast or slow heart rate, decreased urination, tingling in your hands and feet or around your mouth.

Your cancer treatments may be delayed or permanently discontinued if you have certain side effects.

Common Kadcyla side effects may include:

• easy bruising or bleeding (especially nosebleeds);
• nausea, constipation;
• joint or muscle pain;
• headache; or
• feeling tired.

What is Nerlynx?

Nerlynx is a cancer medicine that interferes with the growth and spread of cancer cells in the body.

Nerlynx is used alone or with other medicines to treat early-stage HER2-positive breast cancer. Nerlynx is also used to treat HER2-positive breast cancer that is advanced or has spread to other parts of the body (metastatic).

Nerlynx is used for breast cancer only if your tumor tests positive for a protein called human epidermal growth factor receptor 2 (HER2). HER2 protein can speed the growth of cancer cells.

Nerlynx is usually given after you have been treated with another medicine called trastuzumab (Herceptin).

Warnings

Nerlynx can cause severe diarrhea, which can be life-threatening if it leads to dehydration. You may be given anti-diarrhea medications for the first 2 months of treatment with Nerlynx.

Call your doctor if you are sick with severe diarrhea, or you also have weakness, dizziness, or a fever.

Before taking this medicine

To make sure Nerlynx is safe for you, tell your doctor if you have ever had:

• liver disease.

You may need to have a negative pregnancy test before starting this treatment.

Neratinib can harm an unborn baby or cause birth defects if the mother or the father is using this medicine.

• If you are a woman, do not use Nerlynx if you are pregnant. Use effective birth control to prevent pregnancy while you are using this medicine and for at least 1 month after your last dose.
• If you are a man, use effective birth control if your sex partner is able to get pregnant. Keep using birth control for at least 3 months after your last dose.
• Tell your doctor right away if a pregnancy occurs while either the mother or the father is using Nerlynx.

Do not breastfeed while using this medicine, and for at least 1 month after your last dose.

How should I take Nerlynx?

Take Nerlynx exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

The usual dose of Nerlynx is 6 tablets taken once daily. Take the medicine with food, at the same time each day.

You may need to take this medicine daily for up to one year. Nerlynx is sometimes taken daily in 21-day treatment cycles until the medicine stops working or until you have serious side effects.

Your doctor will determine how long to treat you with this medicine. Follow your doctor’s dosing instructions very carefully.

Swallow the tablet whole and do not crush, chew, or break it.

Nerlynx can cause severe diarrhea, which can be life-threatening if it leads to dehydration. For the first 2 months of treatment with Nerlynx, you may need to take medication to prevent or quickly treat diarrhea.

Your doctor may recommend you have an anti-diarrhea medicine such as loperamide (Imodium) available at all times while you are taking Nerlynx. Take the anti-diarrhea medicine exactly as prescribed by your doctor.

To best control diarrhea, you may need to follow a special diet. Get familiar with the list of foods you should eat or avoid to help control diarrhea. You may also need to drink extra fluids to keep from getting dehydrated.

Tell your doctor if you have more than 2 bowel movements in 1 day.

Call your doctor if you are sick with severe diarrhea, or you also have weakness, dizziness, or a fever. You may need to stop taking this medicine for a short time.

You may need frequent blood tests.

Store at room temperature away from moisture and heat.

Dosing information

Usual Adult Dose for Breast Cancer — Adjuvant:

240 mg orally once a day continuously for 1 year

NOTE: Antidiarrheal prophylaxis is recommended during the first 2 cycles (56 days) of therapy and should be initiated with the first dose. Titrate loperamide to 1 to 2 bowel movements per day.
MANUFACTURER SUGGESTED PROPHYLACTIC LOPERAMIDE DOSING:
-Weeks 1 and 2 (days 1 through 14): 4 mg orally 3 times a day
-Weeks 3 through 8 (days 15 through 56): 4 mg orally 2 times a day
-Weeks 9 through 52 (days 57 through 365): 4 mg as needed (not to exceed 16 mg per day)

Use: For the extended adjuvant treatment of adult patients with early stage HER2-overexpressed/amplified breast cancer (to follow adjuvant trastuzumab-based therapy)

What happens if I miss a dose?

Skip the missed dose and use your next dose at the regular time. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include severe diarrhea or vomiting, stomach pain, increased thirst, decreased urination, dark urine, dizziness, or hot and dry skin.

What to avoid

Grapefruit may interact with neratinib and lead to unwanted side effects. Avoid the use of grapefruit products.

Ask your doctor before using an antacid or stomach acid reducing medicine. Use only the type your doctor recommends.

Nerlynx side effects

Get emergency medical help if you have signs of an allergic reaction to Nerlynx: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• severe or ongoing diarrhea;
• pain or burning when you urinate;
• kidney problems – little or no urination, swelling in your feet or ankles, feeling tired or short of breath; or
• liver problems – right-sided upper stomach pain, vomiting, tiredness, fever, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Your cancer treatments may be delayed or permanently discontinued if you have certain side effects.

Common Nerlynx side effects may include:

• kidney problems;
• abnormal liver function tests;
• diarrhea, constipation;
• painful urination;
• nausea, vomiting, stomach pain, bloating;
• upset stomach, loss of appetite;
• dizziness, feeling weak or tired;
• nosebleed;
• rash, dry skin, problems with your fingernails or toenails;
• dry mouth, mouth sores;
• back pain, joint pain, muscle spasms;
• weight loss; or
• cold symptoms such as stuffy nose, sneezing, sore throat.