Classification: Monoclonal Antibody
About Pertuzumab (Perjeta®)
Pertuzumab is a type of monoclonal antibody, which is a group of medications that are designed to target a specific type of cell (in this case, a Her2 positive breast cancer cell). Her2 is overexpressed in some breast cancers and is associated with a poorer prognosis. Antibodies, which are normally found in the body, are developed by the immune system to destroy foreign things (such as a germ). Pertuzumab is an antibody that is made in a laboratory, with the goal of stimulating the patient's immune system to attack the breast cancer cells. Pertuzumab may also block Her2+ cells from dividing. This medication may be given in conjunction with traztuzumab because they target different areas of the Her-2 cells.
How to Take Pertuzumab
Pertuzumab is given by IV (intravenous) infusion. The first dose is given over an hour, with subsequent doses given every 3 weeks sometimes infused over less than an hour.
Possible Side Effects of Pertuzumab
There are a number of things you can do to manage the side effects of pertuzumab. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Some patients experience a reaction during or within 24 hours of the first infusion. Reactions can range from minor to serious and may include difficulty breathing, cough, wheezing, drop in blood pressure, flushing, rash and swelling. If this occurs during the infusion, it would be stopped, and Tylenol and/or diphenhydramine given to lessen these reactions. The infusion may be restarted once symptoms resolve, if your doctor determines it is safe to do so. This typically does not happen with subsequent infusions.
Diarrhea is a common side effect of pertuzumab and is potentially dangerous because it can lead to serious dehydration. Diarrhea can be defined as an increase in the number of bowel movements you have in a day. Your healthcare team will tell you how to take loperamide (an anti-diarrheal medication), which you should start taking as soon as diarrhea develops. Notify your healthcare team if the diarrhea does not stop on this medication so they can help you better manage this side effect.
Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
Nausea and Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Decrease in Appetite
Nutrition is an important part of your care. Cancer treatment can affect your appetite and, in some cases, the side effects of treatment can make eating difficult. Ask your nurse about nutritional counseling services at your treatment center to help with food choices.
- Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
- If you are not eating enough, nutritional supplements may help.
- You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.
- Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell. Sometimes cold food has less of an odor.
- Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary to add flavor. Bacon, ham and onion can add flavor to vegetables.
Pertuzumab may cause cardiac (heart) dysfunction, including severe heart failure (congestive heart failure). Patients should have their heart function tested prior to starting this therapy and during therapy if any symptoms arise. If heart function decreases, pertuzumab should be stopped. You should report to your healthcare team any symptoms of cardiac dysfunction, including: feeling like your heart is racing or pounding, dizziness, unusual tiredness, lightheadedness or shortness of breath.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bath daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your doctor or nurse before scheduling dental appointments or procedures.
- Ask your doctor or nurse before you, or someone you live with, has any vaccinations.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Loss or Thinning of Scalp and Body Hair (Alopecia)
Your hair may become thin, brittle, or may fall out. This typically begins two to three weeks after treatment starts. This hair loss can be all body hair, including pubic, underarm, legs/arms, eyelashes, and nose hairs. The use of scarves, wigs, hats and hairpieces may help. Hair generally starts to regrow soon after treatment is completed. Remember your hair helps keep you warm in cold weather, so a hat is particularly important in cold weather or to protect you from the sun.
Peripheral Neuropathy (Numbness or Tingling in the Hands and/or Feet)
Peripheral neuropathy is a toxicity that affects the nerves. It causes a numbness or tingling feeling in the hands and feet, often in the pattern of a stocking or glove. This can get progressively worse with additional doses of the medication. In some people, the symptoms slowly resolve after the medication is stopped, but for some it never goes away completely. You should let your healthcare provider know if you experience numbness or tingling in the hands and feet, as they may need to adjust the doses of your medication.
Other Side Effects
Some less common side effects that have been reported include: rash and anemia (low red blood cell count).
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment, even if your menstrual cycle stops or you believe your sperm is affected. You should consult with your healthcare team before breastfeeding while receiving this medication.