Trastuzumab emtansine (Kadcyla®)
Trastuzumab emtanzine is a targeted therapy used to treat certain HER2 positive breast cancers that have spread or come back. It is also known as Kadcyla ®. It may also be used to treat other HER2 cancers as part of a clinical trial.
What is trastuzumab emtansine?Back to top
Trastuzumab emtansine is made of two different drugs joined together in one drug. Trastuzumab is a monoclonal antibody that works by ‘targeting’ specific proteins (receptors) on the surface of cells. The other drug emtansine is a chemotherapy drug, which damages cancer cells.
Trastuzumab emtansine (Kadcyla®) is not the same as trastuzumab (Herceptin®). We have separate information about trastuzumab (Herceptin®) that we can send you.
How trastuzumab emtansine worksBack to top
Some breast 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 breast cancers. The extra HER2 receptors help the cancer cells to divide and grow.
Trastuzumab emtansine locks on to the HER2 proteins on the cancer cell. This blocks the receptors and stops the cells from dividing and growing. It also releases the chemotherapy drug directly into the cancer cell so that it damages and destroys it from inside the cell.
We have more information about HER2 positive breast cancer.
When trastuzumab emtansine is givenBack to top
This drug can be used to treat people with HER2 breast cancer that has spread to other parts of the body, or come back in the same area. You need to have had previous treatment with trastuzumab (Herceptin®) and docetaxel or paclitaxel.
This drug is not widely available on the NHS as it hasn’t been approved by the organisations that advise the NHS on new drugs. Their decisions were made based on the cost of the drug.
Some people may be given trastuzumab emtansine as part of a clinical trial, or after a doctor has applied for it to be individually funded. We can send you more information on what to do if a treatment isn’t available on the NHS.
How trastuzumab emtansine is givenBack to top
You have trastuzumab emtansine in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have treatment. You will also see a doctor or nurse before you have treatment. They will ask you about how you ave been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
If your blood results are not back to normal or if you’ve been having certain side effects, the doctor may delay your treatment or lower your dose of trastuzumab emtansine.
Your nurse gives you trastuzumab emtansine through one of the following:
- a short thin tube (cannula) that the nurse puts into a vein in your arm or hand
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
The nurse gives you trastuzumab emtansine as a drip (infusion). They usually run the drip through a pump, which gives you the treatment over a set time. The first infusion will take about 90 minutes. After this, you can have it over about 30 minutes.
When the trastuzumab emtansine is being given
Some people might have side effects while they are having the treatment:
Trastuzumab emtansine may cause an allergic reaction while it’s being given. This is more common with the first treatment, so you have the first dose slowly over 90 minutes. The nurse will give you drugs to help prevent or reduce a reaction. They will monitor you during and after each treatment. If you have a reaction, they will treat it quickly.
Signs of a reaction can include: flu-like symptoms (headaches, high temperature or chills), feeling flushed, dizzy or short of breath, having pain in your back, tummy or chest, or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
Rarely, a reaction can happen a few hours after treatment. If you develop any of these symptoms or feel unwell after you get home, contact the hospital straight away for advice.
Your course of trastuzumab emtansine
You have trastuzumab emtansine as a course of several sessions (or cycles) of treatment over a few months. Each cycle of treatment usually takes 21 days (three weeks). You have the trastuzumab emtansine on the first day of the cycle. You will then have a rest period for 20 days. At the end of the 21 days, you start your second cycle of treatment.
Trastuzumab emtansine is given for as long as it keeps the cancer under control. Your doctor or nurse will tell you more about the number of cycles you are likely to have.
Before you go home the nurse of pharmacist will give you anti-sickness drugs to take. Take all your tablets exactly as they have explained to you.
Possible side effects of trastuzumab emtansineBack to top
We explain the most common side effects of trastuzumab emtansine here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these.
It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you.
Your nurse will give you advice about managing your side effects. After your treatment is over, they will start to improve.
Contact the hospital
Your nurse will give you a telephone number or numbers to call the hospital if you feel unwell or need advice any time day or night. Save these numbers in your mobile phone or keep them somewhere safe.
Risk of infection
The drug can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
- your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
This drug can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
This drug can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red cells (blood transfusion).
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after. Try to pace yourself and get as much rest as you need. It helps to balance this with taking some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
This may happen in the first few days after treatment but it is usually mild. Your doctor will prescribe anti-sickness (anti-emetic) drugs to prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you.
Trastuzumab emtansine may make you constipated and cause tummy pain. Drinking at least two litres of fluids (three and a half pints) every day will help. If you are getting constipated try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and take some regular gentle exercise.
If you have any diarrhoea your doctor can prescribe drugs to control it. Take them exactly as explained. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Rarely diarrhoea can be more severe, and it’s important to contact the hospital if this happens. If you have more than three episodes of diarrhoea a day, contact the hospital on the telephone numbers you’ve been given and speak to a doctor or nurse.
A dry mouth is common. Drink plenty of fluids and add sauces and gravies to your food to keep it moist. Sucking ice cubes can also help, but don’t do this if you have a sore mouth or other mouth problems. If you have dry lips, using a lip balm or Vaseline® can help.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
You may get a rash, which may be itchy. Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes. Your doctor or nurse can tell you what to expect.
Muscle and/or joint pain
You may get pain or cramps in your joints or muscles for a few days after treatment. Tell your doctor if this happens so they can prescribe painkillers. Let them know if the pain does not get better.
Trastuzumab emtansine may cause headaches. If this happens, let your doctor or nurse know. They can give you painkillers.
Numb or tingling hands or feet
These symptoms are caused by the effect of this drug on the nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks. Always tell your doctor if you have these symptoms.
It usually improves slowly after treatment finishes, but in some people may never go away.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It’s not common and gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Effects on the nervous system
Some people have problems sleeping, feel dizzy or unsteady or find it harder to remember things.
Tell your doctor or nurse if you notice any of these symptoms. It’s important not to drive or operate machinery if you feel dizzy.
Low levels of potassium
Trastuzumab emtansine can lower the levels of potassium in your blood. This is usually mild and goes back to normal after treatment. You will have blood tests before and during treatment to check your potassium levels. Your doctor can prescribe potassium supplements if needed.
Your eyes may become watery, dry or sore eyes or you may get blurred vision. If your eyes get red and inflamed (conjunctivitis), tell your doctor. You may need antibiotic eye drops. Always tell your doctor or nurse if you notice any changes in your eyes or vision.
Some people may notice that their hair gets a little thinner. This will return to normal after treatment finishes.
Less common side effects of trastuzumab emtansineBack to top
Effects on the lungs
This drug may cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, fever or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
Changes in the way the liver works
Trastuzumab emtansine may affect how your liver works. This is usually mild and goes back to normal after treatment. You’re unlikely to notice any changes, but your doctor will check how well your liver is working with regular blood tests.
Changes in the way the heart works
This drug can sometimes affect the way the heart works. You will have tests to see how well your heart is working before, during and sometimes after treatment.
If you have pain or tightness in your chest, feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions but it’s important to get them checked by a doctor.
Side effects can usually be controlled or improved. Always let your doctor or nurse know about any side effects you have so they can help you feel better.
Other information about trastuzumab emtansineBack to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and trastuzumab emtansine may add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines, including ones you can buy in a shop or chemist, can interact with or be harmful when you are having trastuzumab emtansine. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
It’s not known if trastuzumab emtansine affects your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because trastuzumab emtansine may harm a developing baby. It’s important to use effective contraception during and for seven months after the last treatment. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having this drug you need to use a condom. This is to protect your partner in case there is any drug in your semen or vaginal fluid.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is any of the drug in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having this drug. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having a targeted therapy.
The information in this section has been produced in accordance with the following sources and guidelines:
If you’d like further information on the sources we use, please feel free to contact us.
Thanks to Dr Helen Neville-Webbe, Consultant in Medical Oncology; Jenny King, Chemotherapy Nurse Specialist; Tariro Whingwiri, Senior Pharmacist – Haematology/Oncology; and Christine Clarke, Macmillan Specialist Oncology Pharmacistwho reviewed this edition.
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