Pertuzumab, trastuzumab and docetaxel
Pertuzumab, trastuzumab and docetaxel is a chemotherapy treatment used to treat breast cancer that has spread or has come back in the same breast but can’t be treated with surgery.
This information should ideally be read with our general information about chemotherapy and breast cancer.
The drugs used in this treatment are:
- pertuzumab (Perjeta ®) – a targeted therapy drug
- trastuzumab (Herceptin ®) – a targeted therapy drug
- docetaxel (Taxotere ®) – a chemotherapy drug
Pertuzumab and trastuzumab both 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.
Pertuzumab and trastuzumab work by locking onto HER2 proteins. Each drug locks on to a different part of the protein. This blocks the receptors and stops the cells dividing and growing.
Pertuzumab and trastuzumab only work in people who have cancer with high levels of HER2. There are several tests that can measure HER2 levels. Testing can be done when you first have surgery for your cancer. Samples of cancer cells from previous biopsies or surgery can also be used. We have more information on HER2 and breast cancer , including HER2 testing.
Pertuzumab may only be available in some situations. Your cancer doctor can tell you if it’s appropriate for you. Some people may be given it as part of a clinical trial. If a drug isn’t available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice. We have further information on what you can do if a treatment isn’t available.
How pertuzumab, trastuzumab and docetaxel are givenBack to top
You usually have treatment in the chemotherapy day unit. 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 a 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 the treatment.
You will also see a doctor or nurse. They will ask you how you have been. They will also test your urine and check your blood pressure. If your blood results are alright on the day of your treatment, the pharmacist will prepare the treatment for you. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness (anti-emetic) drugs, and sometimes a steroid as an injection into a vein. They give you these drugs and your treatment through a drip or infusion connected to a pump, so it is given over a set time. The drip is attached to 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).
Pertuzumab is usually given first, over an hour. The nurse will monitor you for an hour afterwards for any reaction. If you have no problems with the first dose, you can have further doses over 30–60 minutes.
The first dose of trastuzumab 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. If you have no problems, you will have your next dose over 30–90 minutes, and you’ll be able to go home soon after it finishes.
Docetaxel is usually given over an hour. Your nurse will give you anti-sickness drugs and sometimes a steroid as an injection through the drip. Sometimes you are given steroid tablets to start taking the day before instead.
Your course of pertuzumab, trastuzumab and docetaxel
The drugs are given as a course of several treatments (cycles) over a few months. You will usually have six cycles of docetaxel with pertuzumab and trastuzumab. You may continue to have just pertuzumab and trastuzumab after this. Your doctor or nurse will tell you the number of cycles you are likely to have.
You will have the treatment every three weeks. For the first cycle, you may have pertuzumab and trastuzumab on day one and the docetaxel the next day. The number of days the treatment is given over can vary between hospitals. You will then have a rest period and start the next cycle three weeks later.
If you have no problems with the first cycle of treatment, you will have all three drugs on the same day for the other cycles. You will usually have a higher dose of pertuzumab and trastuzumab with the first treatment.
When pertuzumab, trastuzumab and docetaxel are being given
Some people might have the following side effects while they are having the treatment:
Trastuzumab may cause temporary flu-like symptoms while it is being given. 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. If you experience them, you generally get better within a few hours of the infusion finishing.
The treatment may cause an allergic reaction while it’s being given. This is more common with the first treatment. Your nurse will monitor you for any signs of a reaction. If you have a reaction, they will treat it quickly with drugs.
Signs of a reaction can include:
- flu-like symptoms (headaches, high temperature or chills)
- feeling sick
- a rash
- feeling itchy, flushed or short of breath
- pain in your back, tummy or chest
- swelling of your face or lips
- feeling dizzy
- 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.
When you have docetaxel, you’re usually given steroid tablets to take at home the day before the treatment to reduce the chance of a reaction. It’s important to take the steroid tablets exactly as your nurse or doctor has explained. Instead of steroid tablets, you may be given a steroid by injection into the vein (intravenously) 30–60 minutes before the docetaxel is given.
Pain along the vein
If you have this, tell your nurse straight away. They will check your drip site and slow the drip to ease the pain.
Before you go home, the nurse or pharmacist will give you anti-sickness tablets to take. Take all your tablets exactly as your nurse or pharmacist has explained.
Possible side effects of this treatmentBack to top
We explain the most common side effects 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 side effects. It is very important to take them 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.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you a telephone number or numbers to call the hospital if you feel unwell or need advice at any time of the day or night. Save these numbers in your mobile phone or keep them somewhere safe.
More information about these drugs
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information, you can visit the electronic Medicines Compendium (eMC).
Risk of infection
Your treatment can reduce the number of white 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 – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
Your white blood cells usually increase steadily and return to normal before your next treatment. You will have a blood test before having more chemotherapy. If your number of white blood cells is still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
The treatment 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. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
The treatment 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 blood cells (blood transfusion).
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluid every day if you have diarrhoea.
This may happen in the first few days after the treatment. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Loss of appetite
You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
Pertuzumab may make you constipated. Drinking at least two litres (three and a half pints) of fluid every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and do some regular, gentle exercise.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Pertuzumab and trastuzumab may cause headaches. If this happens, let your doctor or nurse know. They can give you painkillers.
Pertuzumab can cause 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.
Effects on the heart
Pertuzumab and trastuzumab may affect the way your heart works. This should get better once the treatment stops. You will have tests to check your normal heart function before starting treatment and at regular intervals during treatment. Let your doctor know straight away if you have:
- a cough
- shortness of breath when sleeping flat
- swelling in your legs or arms.
Pertuzumab and trastuzumab are not recommended for people with a history of heart disease or high blood pressure.
Sore mouth (stomatitis)
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 or dentures every 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 to 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 bitter or metallic taste in your mouth from the docetaxel or find that food tastes different. This should go away when your treatment finishes. Try using herbs and spices (unless you have a sore mouth or ulcers) or strong-flavoured sauces to give your food more flavour. Sucking boiled sweets can sometimes help get rid of a bitter or metallic taste. Your nurse can give you more advice.
Muscle and/or joint pain
The docetaxel may cause pain 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. Try to get plenty of rest. Having regular warm baths may help.
Numb or tingling hands or feet
These symptoms are caused by the effect of docetaxel on the nerves. Trastuzumab may also cause this. 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. They may be able to control them by lowering the dose of the drug. The symptoms usually improve slowly after treatment finishes, but in some people they may never go away. Talk to your doctor if you are worried about this.
You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends, but rarely, the hair loss is permanent. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss. We also have more information about coping with hair loss.
Scalp cooling is a way of lowering the temperature of the scalp to help reduce hair loss. Your nurse can tell you if this is an option for you.
Docetaxel may cause your nails to become brittle and break easily. They may get darker or discoloured, and you may get lines or ridges on them. These changes usually grow out over several months after treatment finishes. Rarely, nails may come off, but they will grow back after treatment. Wearing gloves when washing dishes or using detergents will help protect your nails during treatment. If you get pain, redness or swelling around your nails, let your nurse or doctor know.
Build-up of fluid
You may put on weight, or your ankles and legs may swell because of fluid building up. This can be caused by the docetaxel or pertuzumab. While you’re having the docetaxel treatment, the steroid tablets your doctor prescribes will help prevent this. Tell your doctor or nurse if fluid builds up. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion. The swelling will get better after your treatment ends.
Less common side effects of this treatmentBack to top
Changes to your lungs
Rarely, docetaxel can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, a fever or breathlessness. 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.
The pertuzumab and the docetaxel may make your eyes become watery. If your eyes also get red and feel sore, tell your doctor or nurse. This is usually due to an infection (conjunctivitis), which can be treated with antibiotic eye drops.
Soreness and redness of palms of hands and soles of feet
Docetaxel can cause this. It is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse can give you advice and 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.
It’s important to let your doctor or nurses know straight away if you feel unwell or have severe side effects, including any we don’t mention here. Remember that you may get other side effects that are not listed here if you are having chemotherapy.
Other information about this treatmentBack to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and treatment with pertuzumab and other drugs can add to this. A clot can cause symptoms such as:
- pain, redness and swelling in a leg
- 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 your treatment or be harmful when you are having treatment. It’s important to tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Docetaxel contains alcohol. Tell your doctor, nurse or pharmacist if this is a problem for you. This treatment may affect your ability to drive or operate machinery.
Pertuzumab, trastuzumab and docetaxel can affect your fertility (being able to get pregnant or father a child). If you’re worried about this it’s important to talk to your doctor before treatment starts.
Your doctor will advise you not to become pregnant or father a child during treatment. The drugs may harm a developing baby. It’s important to use contraception during and for a few months after treatment. You can talk to your doctor or nurse about this.
You also need to use a condom if you have sex within the first couple of days of having your treatment. This is to protect your partner in case there is any of the drugs in your semen or vaginal fluid.
Women are advised not to breastfeed during treatment and for a few months afterwards. This is in case there are any of the drugs 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 you’re having this treatment. Tell them the name of your cancer doctor so they can ask for advice.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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