Trastuzumab, which is commonly known as Herceptin®, may be used to treat breast and stomach cancer. It may also be used to treat other types of cancer as part of a cancer research trial.
You'll see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Herceptin is one of a group of cancer drugs called monoclonal antibodies. Monoclonal antibodies are sometimes called targeted therapies because they work by ‘targeting’ specific proteins (receptors) on the surface of cells.
Some cancers have too much of a protein called human epidermal growth factor receptor 2 (HER2) on the surface of their cells. These are called HER2 positive cancers. The extra HER2 receptors stimulate the cancer cells to divide and grow.
Herceptin locks on to the HER2 protein. This blocks the receptor and stops the cells from dividing and growing.
Herceptin only works in people who have cancer with high levels of the HER2 protein. Several tests are available to measure HER2 levels. Testing can be done at the same time as initial cancer surgery, or samples of cancer cells from previous biopsies or surgery may be used. We have more information on HER2 and breast cancer, including HER2 testing.
When Herceptin is used
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Herceptin is licensed to treat people with HER2 positive early stage breast cancer following surgery and chemotherapy, or sometimes at the same time as chemotherapy. It’s given to reduce the risk of the cancer coming back and increase the chance of a cure.
Herceptin is also given to people with advanced (or metastatic) breast cancer that has spread to other parts of the body or come back after initial treatment. In this situation, it’s either given on its own or in combination with chemotherapy and/or hormone therapy.
Herceptin is licensed to treat people with HER2 positive adenocarcinoma of the stomach that has spread (metastatic or advanced gastric cancer). It may also be used to treat advanced cancers in the area where the gullet (oesophagus) joins the stomach - the gastro-oesophageal junction. It is used in combination with chemotherapy in both cases.
The National Institute for Health and Clinical Excellence (NICE) gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) makes recommendations on the use of new drugs within the NHS in Scotland. NICE recommends the use of Herceptin in the treatment of both breast and gastric (stomach) cancer. The SMC only recommends its use in breast cancer.
If you live in Northern Ireland, speak to your cancer specialist about whether Herceptin is recommended to treat your type of cancer.
If Herceptin isn’t recommended for you, it may not be available on the NHS, although you may be given it as part of a cancer research trial (clinical trial). We have more information on what you can do if a treatment isn't available.
What Herceptin looks like
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Herceptin is a clear to light yellow fluid.
How Herceptin is given
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Herceptin is given by a drip into a vein (intravenous infusion). It can usually be given in the outpatient department at the hospital.
The first dose (infusion) is given slowly, usually over an hour and a half. You'll then need to stay in hospital for about 4-6 hours so the nurses can monitor you for any reaction to the Herceptin. If you have no problems with this, later infusions will normally take about 30-90 minutes and you'll be able go home soon after they finish.
Depending on your situation, Herceptin is given once a week or once every three weeks. In early stage breast cancer it is usually given for up to a year. When given to treat advanced breast or stomach cancer, Herceptin is given for as long as it keeps the cancer under control.
Each person’s reaction to a cancer drug is different. Some people have very few side effects, while others may experience more.
We've outlined the most common side effects here, but haven't included those that are rare and therefore unlikely to affect you.
If you notice any effects that aren't listed here, discuss them with your doctor or nurse.
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 the 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
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.
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. Antihistamines can be given before the infusion to reduce the chance of you having an allergic reaction.
Later side effects
Herceptin can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it’s severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Some people find that Herceptin causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
Feeling sick (nausea)
This can be troublesome for a day or two after the infusion. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting.
If the sickness isn't controlled, or if it continues, tell your doctor as they can prescribe other anti-sickness drugs that may work better for you. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
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.
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.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Some medicines, including those that you can buy in a shop or chemist, can be harmful to take while you’re having Herceptin. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
It's not advisable to become pregnant or father a child while having Herceptin, as it may harm the developing baby. It’s important to use effective contraception while having this drug, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether biological therapies can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after treatment.
There is a potential risk that Herceptin may be present in breast milk, so women are advised not to breastfeed while having this treatment and for a few months afterwards.
It's not known what effects Herceptin may have on your ability to have children in the future. If you have concerns about fertility, it's important to discuss them with your doctor before beginning treatment.
Non-cancer hospital admission
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having Herceptin treatment. You should tell them the name of your cancer specialist so they can ask them for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
This information has been compiled using a number of reliable sources including:
British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary. 63rd edition. 2012. British Medical Association and Royal Pharmaceutical Society of Great Britain.
National Institute for Health and Clinical Excellence (NICE). Trastuzumab for the adjuvant treatment of early-stage HER2-positive breast cancer (TA107). August 2006. National Institute for Health and Clinical Excellence (NICE).
National Institute for Health and Clinical Excellence (NICE).Trastuzumab for the treatment of HER2-positive metastatic gastric cancer (TA208). November 2010. National Institute for Health and Clinical Excellence (NICE).
National Institute for Health and Clinical Excellence (NICE). Breast cancer (early & locally advanced): diagnosis and treatment (CG80). February 2009. National Institute for Health and Clinical Excellence (NICE).
National Institute for Health and Clinical Excellence (NICE). Guidance on the use of trastuzumab for the treatment of advanced breast cancer (CG81). March 2002. National Institute for Health and Clinical Excellence (NICE).
Scottish Medicines Consortium (SMC). Advice on 623/10 - Trastuzumab (Herceptin) Resubmission. February 2011. Scottish Medicines Consortium (SMC).
With thanks to Mr Bruce Burnett, Consultant Pharmacist, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.