Our Therapies

HERCEPTIN® Infusion Therapy

autoimmune condition affecting the eyes and surrounding tissues

About HERCEPTIN® Infusion Therapy

HERCEPTIN® (trastuzumab) is a targeted biologic therapy given as an intravenous (IV) infusion. It is a humanized monoclonal antibody, a HER2/neu receptor antagonist, that attaches to the HER2 protein on the surface of cancer cells and blocks the growth signals those cells depend on. It also helps your immune system recognize and attack cells that overexpress HER2.

It helps to know what this therapy is and what it is not. HERCEPTIN® is a targeted antibody aimed at a specific protein on your tumor. It is not an immunotherapy that releases the brakes on your immune system, so it works differently from the checkpoint inhibitors you may have read about.

Treatment begins only after an FDA-approved HER2 test confirms that your cancer overexpresses the HER2 protein or carries extra copies of the HER2 gene. If you are being treated for gastric or gastroesophageal junction cancer, the test must be one validated for gastric tissue, because HER2 staining behaves differently there than it does in breast tissue.

Your dose is based on your weight, and treatment follows one of two rhythms:

Weekly: a 4 mg/kg loading dose infused over 90 minutes, then 2 mg/kg over 30 minutes each week
Every three weeks: an 8 mg/kg loading dose infused over 90 minutes, then 6 mg/kg over 30 to 90 minutes

If you are receiving adjuvant treatment for breast cancer on the weekly schedule with paclitaxel or docetaxel (12 weeks), or with docetaxel and carboplatin (18 weeks), you switch to 6 mg/kg every three weeks one week after your last weekly dose and continue to complete 52 weeks of therapy in total. Adjuvant treatment beyond one year is not recommended. If you are being treated for metastatic breast cancer or metastatic gastric cancer, treatment continues until the disease progresses.

A few medication safety rules guide every infusion:

It is given only as an IV infusion, never as an IV push or bolus
It is never mixed with other medications in the same bag or line
Its instructions are different from those for subcutaneous trastuzumab products
It is never substituted for, or with, ado-trastuzumab emtansine or fam-trastuzumab deruxtecan

Your heart function is checked before your first dose and at regular intervals throughout treatment. If you miss a dose by a week or less, it is given as soon as possible at your usual maintenance dose. If more than a week goes by, your team gives a re-loading dose over about 90 minutes before returning to your regular schedule.

Conditions treated by this therapy

HERCEPTIN® is used only when a HER2 test confirms that your cancer overexpresses the HER2 protein. Once that test is complete, your care team may consider this therapy for:

Adjuvant treatment of HER2-overexpressing breast cancer that is node-positive, or node-negative with high-risk features, as part of a regimen with doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel
Adjuvant treatment of HER2-overexpressing breast cancer with docetaxel and carboplatin
Adjuvant treatment of HER2-overexpressing breast cancer as a single agent following multi-modality anthracycline-based therapy
First-line treatment of HER2-overexpressing metastatic breast cancer, in combination with paclitaxel
HER2-overexpressing metastatic breast cancer, as a single agent after one or more prior chemotherapy regimens for metastatic disease
HER2-overexpressing metastatic gastric or gastroesophageal junction adenocarcinoma, in combination with cisplatin and either capecitabine or 5-fluorouracil, in patients who have not had prior treatment for metastatic disease

HERCEPTIN® is approved for adults. Its safety and effectiveness in children have not been established.

Your oncologist will confirm whether HERCEPTIN® is right for you before treatment begins.

HERCEPTIN® Price

The cost of prescription medications can vary depending on your insurance coverage. If you're concerned about the price of your medication:

Contact your insurance provider to understand your coverage
Ask your doctor or pharmacist about lower-cost alternatives
Check with the drug manufacturer about financial assistance programs
Explore patient assistance options if you're uninsured or underinsured

Remember, many resources exist to help patients access necessary medications. Don't hesitate to ask for help if you're struggling with medication costs. No patient should go without necessary treatment due to financial limitations. If you have questions about financial assistance opportunities, contact a member of our Violet Health team.

What to Expect During HERCEPTIN® Infusion Therapy

When you arrive at our Violet Health location, you'll settle into a private, welcoming space designed with your comfort and peace of mind in mind. Before and during your intravenous infusion, our experienced team will:

Review your current health status and any new symptoms, including shortness of breath, a new or worsening cough, swelling in your legs or ankles, or rapid weight gain
Check your vital signs
Confirm your weight at every visit, since your dose is calculated from it
Confirm that your heart function monitoring is current
Place your IV using gentle, practiced technique
Administer your HERCEPTIN® infusion with our nursing team at your side
Monitor you closely for any infusion-related reactions, which are most common with the first dose
Protect your privacy and comfort throughout the visit

Your dose is prepared with care. HERCEPTIN® is diluted in 0.9% sodium chloride, never in dextrose, and it runs through a dedicated line with nothing else mixed in.

Your first loading dose takes about 90 minutes, followed by an observation period so our team can watch for any reaction. Later maintenance doses usually run 30 to 90 minutes, so most visits after the first one are shorter.

Chills and fever during the first infusion are common, reported by roughly 40% of patients in clinical trials. They are usually managed with acetaminophen, an antihistamine, and slowing the infusion rate, and they tend to be much less of an issue with later doses.

Your schedule depends on your treatment plan. Some people come weekly, and others come every three weeks. If you are on weekly adjuvant treatment with chemotherapy, you switch to the every-three-week schedule one week after your last weekly dose. Adjuvant treatment adds up to 52 weeks in total, while treatment for metastatic disease continues as long as it keeps working for you. On days when you also receive chemotherapy, your HERCEPTIN® infusion is given first.

HERCEPTIN® Side Effects

As with any medication, HERCEPTIN® may cause side effects. Being informed helps you know what to watch for and when to contact your healthcare team. In the breast cancer studies, the most common reactions were:

Fever
Chills
Nausea
Vomiting
Diarrhea
Infusion reactions
Infections
Cough
Headache
Fatigue
Shortness of breath
Rash
Low white blood cell counts
Anemia
Muscle and joint pain
Trouble sleeping
Nail changes

If you are being treated for metastatic gastric cancer, the pattern of side effects looks a little different, because HERCEPTIN® is given with chemotherapy in that setting. The most commonly reported reactions were:

Neutropenia, a low count of infection-fighting white blood cells
Diarrhea
Fatigue
Anemia
Stomatitis, or sore mouth and lips
Weight loss
Upper respiratory infections
Fever
Thrombocytopenia, a low platelet count
Mucosal inflammation
Nasopharyngitis, or cold-like symptoms
Changes in the way food tastes

Boxed Warning: HERCEPTIN® carries the FDA's strongest warning for four serious risks. Please alert our clinical staff or seek medical attention immediately if you notice any of the symptoms below.

Cardiomyopathy: HERCEPTIN® can cause a drop in your left ventricular ejection fraction and congestive heart failure, and the risk is highest when it is given with anthracycline chemotherapy. Report shortness of breath, swelling in the legs or ankles, rapid weight gain, dizziness, an irregular or racing heartbeat, or a persistent cough.
Infusion reactions: Serious and even fatal infusion reactions have occurred, usually during the infusion or within 24 hours of it. Report trouble breathing, wheezing, throat tightness, hives, or feeling faint.
Pulmonary toxicity: This can include interstitial pneumonitis, pulmonary infiltrates, pleural effusions, non-cardiogenic pulmonary edema, and acute respiratory distress syndrome. It can be more severe if you already have lung disease or extensive tumor involvement in the lungs. Report new or worsening shortness of breath, cough, or fever.
Embryo-fetal toxicity: Exposure during pregnancy can cause low amniotic fluid, which can lead to underdeveloped lungs, skeletal abnormalities, and newborn death.

Other serious risks are less common, and they are worth knowing about so you can speak up early:

Worsening of chemotherapy-induced neutropenia, including febrile neutropenia
Serious infection
Blood clots
Kidney problems, including rare cases of nephrotic syndrome and glomerulopathy
Immune thrombocytopenia, a low platelet count caused by the immune system
Tumor lysis syndrome, most often in people with a large tumor burden

Heart monitoring: You have an echocardiogram or MUGA scan before your first dose. Your left ventricular ejection fraction, or LVEF, is then checked every three months during treatment and again when treatment is complete. If treatment is held because of a significant decline, your LVEF is rechecked every four weeks. After adjuvant therapy ends, checks continue every six months for at least two years.

Treatment is held for at least four weeks if your LVEF drops by 16% or more in absolute terms, or if it falls below your lab's normal range along with an absolute drop of 10% or more. It is stopped permanently if the decline lasts more than eight weeks, or if treatment has already been held three times for heart problems.

Anthracycline timing: Trastuzumab takes about seven months to clear your body. Because of that, anthracycline-based chemotherapy is avoided for up to seven months after your last dose whenever possible. If it is needed sooner, your care team will monitor your heart closely.

Pregnancy and breastfeeding: Your pregnancy status is verified before your first dose. Use effective contraception during treatment and for seven months after your last dose, and do not breastfeed during that same window. If you become pregnant during treatment or within seven months of your last dose, tell your care team right away. The manufacturer runs a pregnancy pharmacovigilance program that follows these exposures.

HERCEPTIN® Infusion Therapy at Violet Health

Your comfort during HERCEPTIN® infusion therapy at Violet Health is our priority. Our patients enjoy walk-up parking, complimentary entertainment and snacks, and a team of highly trained providers during each treatment. Plus, Violet Health's evening and weekend hours and convenient city and rural locations make it easier to schedule your appointments.