Trastuzumab and pertuzumab (Perjeta®)

Pertuzumab (Perjeta®) and trastuzumab are targeted therapy drugs used to treat breast cancer. They may also be used to treat other cancers. They are usually given with chemotherapy.

It is best to read this information with our general information about targeted therapies and the type of cancer you have.

When pertuzumab and trastuzumab are given together, they are usually given into a vein. But some people may be given trastuzumab as an injection underneath the skin (subcutaneous injection).

You will usually have both pertuzumab and trastuzumab as an outpatient. Your cancer doctor or nurse will tell you how often you will have them.

Like all cancer treatments, pertuzumab and trastuzumab can cause side effects. If you are having these with chemotherapy, you may get some side effects that we have not listed. Some of the side effects can be serious so it is important to read the detailed information below.

Your healthcare team can give you advice on how to manage any side effects. Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we do not mention here. 

Rarely, side effects may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What are pertuzumab (Perjeta®) and trastuzumab?

Pertuzumab and trastuzumab are targeted therapies used to treat breast cancer. They may sometimes be used to treat other cancers. These drugs are usually given with chemotherapy.

It is best to read this information with our general information about targeted therapies and the type of cancer you have. Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.


How pertuzumab and trastuzumab work

Pertuzumab and trastuzumab both work by targeting specific proteins (receptors). 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.

Treatment with pertuzumab and trastuzumab may only be available in some situations. Your cancer doctor can tell you if it is appropriate for you. Some people may have it as part of a clinical trial. If a drug is not 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 is not available.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


How pertuzumab and trastuzumab are given

You will usually be given this treatment in the chemotherapy day unit. A chemotherapy nurse will give it to you. During treatment, you will 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) may 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 about how you have been. If your blood results are okay 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 the treatment through a drip or infusion connected to a pump, so it is given over a set time.

The treatment can be given through:

  • a short thin tube the nurse puts into a vein in your arm or hand (cannula)
  • 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 60 minutes. Some people may react to it the first time they have it. The nurse will monitor you for an hour afterwards for any reaction. If you have no problems with the first treatment, the following treatment can be given over a shorter time.

The first treatment of trastuzumab is also given slowly, usually over 90 minutes. But sometimes you can have it as an injection under the skin. As with pertuzumab, you stay in hospital for a few hours after your first treatment. This is so that the nurses can monitor you for any reaction.

Some hospitals may give the first dose of trastuzumab the day after you have the pertuzumab. After this, if there are no problems, you have them on the same day.

Your nurse will usually give you the chemotherapy after you have had pertuzumab and trastuzumab.

Your course of treatment

You have pertuzumab and trastuzumab once every three weeks. They are usually given with chemotherapy to begin with.

Each cycle takes 21 days (three weeks). You usually have a course of several cycles of treatment over a few months. Your doctor or nurse will discuss your treatment plan with you.

PICC lines and central lines playlist

Watch our short animated videos about having PICC lines and central lines put in.

PICC lines and central lines playlist

Watch our short animated videos about having PICC lines and central lines put in.


About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we haven’t listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.


Side effects while treatment is being given

Some people might have the following side effects while they are having the treatment:

Flu-like symptoms

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.

Allergic reaction

Some people have an allergic reaction while having this treatment. Before treatment, you will be given medicines to help prevent or reduce any reaction. 

Signs of a reaction can include:

  • feeling hot or flushed
  • a skin rash
  • itching
  • shivering
  • feeling dizzy
  • a headache
  • feeling breathless 
  • swelling of your face or lips
  • pain in your back, tummy or chest.

Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.

Sometimes a reaction can happen a few hours after treatment. If you develop any signs or feel unwell after you get home, contact the hospital straight away.

I found the best way of settling nausea was dry biscuits – they really settled my tummy. I found that when I couldn’t drink water, weak orange squash was okay.

Lynn


Common side effects of pertuzumab and trastuzumab

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Bruising and bleeding

This 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 that you cannot explain. This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)

This 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. This is called a blood transfusion.

Effects on the heart

This treatment can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during and sometimes after treatment. If the treatment is causing heart problems, your doctor can change the type of treatment you are having.

Contact a doctor straight away if you:

  • have pain or tightness in your chest
  • feel breathless or dizzy
  • feel your heart is beating too fast or too slowly.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor.

Diarrhoea

Pertuzumab may cause severe diarrhoea. If you have diarrhoea, contact the hospital for advice. They may give you anti-diarrhoea drugs to take. Try to drink at least two litres (three and a half pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Feeling sick

You may feel sick in the first few days after this treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth.

It is more common to have a sore mouth when you are having these drugs with chemotherapy. It will usually improve once you finish the chemotherapy.

Changes to your taste

You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.

Skin changes

This treatment may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. It 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.

Feeling tired

Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop: 

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug or delay treatment for a short time. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Peripheral neuropathy is more common when you are having the drugs with chemotherapy. It may start to improve once you finish the chemotherapy.

Muscle or joint pain

You may have pain in your muscles and stiffness in your joints. Tell your doctor or nurse if this happens. They can prescribe painkillers and give you advice. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.


Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain. 

If you have any of these symptoms, contact a doctor straight away. 

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Other medicines

Some medicines can affect chemotherapy or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment. The drugs may harm the developing baby. It is important to use effective contraception during your treatment.

Breastfeeding

Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.

Fertility

This treatment can affect whether you can get pregnant or father a child.

If you are worried about fertility, it is important to talk with your doctor before you start treatment. There may be ways to preserve fertility for men and women.

Sex

If you have sex during this course of treatment, you need to use a condom. This is to protect your partner in case there is any trace of the drug in semen or vaginal fluids.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.