Biological therapy – Trastuzumab (Herceptin®)
Trastuzumab, which is usually known as Herceptin, is a type of biological therapy called a monoclonal antibody. Monoclonal antibodies recognise and lock onto specific proteins on the surface of cancer cells.
Herceptin is used to reduce the risk of breast cancer coming back in women whose breast cancer cells have a large number of HER2 receptors on their surface. This is called HER2 positive breast cancer.
Herceptin works by attaching to HER2 receptors (proteins) on the surface of breast cancer cells. This stops the cancer cells from dividing and growing. It also works by encouraging the body’s own immune cells to destroy the cancer cells.
You’ll usually have Herceptin every three weeks for a year. It can be given at the same time as your chemotherapy, or on its own after other treatments have finished.
How Herceptin is given
Herceptin is given by injection through a fine tube (cannula) into a vein (intravenously). You’ll have it in the chemotherapy day unit or outpatient department. The first dose is given slowly, usually over about an hour and a half, so the nurses can check you for any reaction that may occur. After this, the infusion will be given over about 30 minutes.
The side effects of Herceptin are usually mild. Some occur during the infusion or within about four hours of the drug being given, particularly with the first dose. These include flu-like symptoms, such as headache, high temperature (fever) and chills, or feeling sick. They generally get better within a few hours of the infusion finishing. Another possible side effect is an allergic reaction, but this is rare. Signs may include a skin rash, itching, wheezing or feeling breathless. You’ll be checked closely during the infusion and if you do have a reaction, it can be treated quickly with drugs.
Side effects can also occur a few days or weeks after treatment. These include:
Effects on the heart
Herceptin may lead to heart problems in some women. Usually, any effect is mild and reversible. Because of this risk, Herceptin isn’t normally given to women who already have heart problems or uncontrolled high blood pressure. You’ll have tests on your heart before treatment to check that it’s healthy, and tests during treatment to make sure Herceptin isn’t causing any damage.
Herceptin and secondary breast cancer
Herceptin is also used to treat secondary or advanced breast cancer (cancer that has spread). It can be used on its own or in combination with chemotherapy. Herceptin is used to treat secondary breast cancer in:
Women with HER2 positive advanced breast cancer who have not had any previous chemotherapy treatment and can’t have a type of chemotherapy called an anthracycline (epirubicin or doxorubicin) should be treated with Herceptin and a chemotherapy called Taxol.
Women who have had two or more previous chemotherapy treatments which included an anthracylcline drug (epirubicin or doxorubicin) and a taxane (Taxol or Docetaxel) should have Herceptin alone.
This section has been compiled using information from a number of reliable sources, including:
Martindale: The Complete Drug Reference (35th edition). Eds Sweetman et al. Pharmaceutical Press, 2006.
Trastuzumab for the Adjuvant Treatment of Early-Stage HER2-Positive Breast Cancer. National Institute for Health and Clinical Excellence (NICE), August 2006.
Breast Cancer (2nd Edition). Roses, D.F. Churchill Livingston, 2005.
Guidance on the Use of Trastuzumab for the Treatment of Advanced Breast Cancer. National Institute for Health and Clinical Excellence (NICE), March 2002
Diseases of the Breast (3rd edition). Eds Harris JR et al. Lippincott Williams & Wilkins, USA, 2004.
Herceptin Plus Chemotherapy After Surgery Improves Survival of Women with Early Stage, HER2-Positive Breast Cancer. Eds Perez E et al. American Society of Clinical Oncology Annual Meeting, May 2005.
For further references, please see general bibliography.