Trastuzumab

INTRODUCTION

Indications

1st-line treatment of metastatic breast cancer (with paclitaxel) that displays overexpression of the human epidermal growth factor receptor 2 (HER2) protein. Treatment of metastatic breast cancer (as monotherapy) that displays overexpression of the human epidermal growth factor receptor 2 (HER2) protein in patients who have already received other chemotherapy regimens. Adjuvant treatment of HER2 overexpressing node-positive or node-negative breast cancer (to be used with alone after multimodality anthracycline-based therapy or as part of 1 of the following regimens: doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel; with docetaxel and carboplatin).

Action

A monoclonal antibody that binds to HER2 sites in breast cancer tissue and inhibits proliferation of cells that overexpress HER2 protein. Therapeutic Effects: Regression of breast cancer and metastases.

Adverse Reactions/Side Effects

CNS: dizziness, headache, insomnia, weakness, depression. Resp: INTERSTITIAL PNEUMONITIS, PULMONARY EDEMA, PULMONARY FIBROSIS, dyspnea, increased cough, pharyngitis, rhinitis, sinusitis. CV: ARRHYTHMIAS, CHF, hypertension, tachycardia. GI: abdominal pain, anorexia, diarrhea, nausea, vomiting. Derm: rash, acne, herpes simplex. F and E: edema. Hemat: anemia, leukopenia. MS: back pain, arthralgia, bone pain. Neuro: neuropathy, paresthesia, peripheral neuritis. Misc: HYPERSENSITIVITY REACTIONS, chills, fever, infection, flu-like syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess signs of congestive heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician immediately.

• Assess any breathing problems that might indicate pulmonary edema, pulmonary fibrosis, or interstitial pneumonitis. Signs include cough, wheezing, chest pain, fever, shortness of breath, and difficult or labored breathing Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Be alert for signs of hypersensitivity reactions. Reactions include pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) and skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor signs of leukopenia (fever, sore throat, signs of infection) or unusual weakness and fatigue that might be due to anemia. Notify physician of these signs immediately.

• Be alert for signs of paresthesias ...