Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)
Pronounce: per-TU-zoo-mab, tras-TU-zoo-mab, and hye-al-yoor-ON-i-dase
Classification: Pertuzumab and Trastuzumab: Monoclonal Antibodies. Hyaluronidase-zzxf: Endoglycoside.
About Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)
An antibody is a protein made by your body to help your immune system find and stop bacteria and viruses from attacking your body. A monoclonal antibody is an antibody made in a lab that can attach to certain cancer cells in your body. Your immune system then attacks and kills the cancer cell that it is attached to. Monoclonal antibodies work with your immune system to kill cancer cells by:
- Helping your immune system attack the cancer cells.
- Blocking growth of the cancer cells.
- Blocking other things the cancer cells need.
Ask your provider about the type of monoclonal antibody you are taking and how it works.
Pertuzumab and trastuzumab are monoclonal antibodies. Pertuzumab and trastuzumab target HER2-positive cancer cells. HER2 receptors on cells send signals telling the cell to grow and divide. Cancers that overexpress HER2 have too many receptors, which cause the cells to grow and divide more quickly. By inhibiting HER2, signals are sent to these cells to slow their growth.
Hyaluronidase is an endoglycoside that helps with the absorption of pertuzumab and trastuzumab.
How To Take Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf
This medication is given as a subcutaneous injection (shot) in the thigh. It is given over several minutes. The dose of each medication and how often you receive them will be decided by your provider. Often it is given every 3 weeks and may be given with other chemotherapies. Because this medication is indicated only for the treatment of HER2-positive cancer, a sample of your tumor will be tested in a lab to determine if it is HER2-positive before starting treatment.
In some cases, a person may have an allergic reaction to this medication. You will be closely monitored during and after the injection. It is also common to have redness and pain and the injection site. If you start to feel dizzy, nauseous, have chills, fever, vomiting, diarrhea, itchy, have trouble breathing, or have chest pain, let your provider know right away.
Possible Side Effects
These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.
Heart Problems
This medication can cause or worsen pre-existing heart problems, like congestive heart failure, restrictive cardiomyopathy, decreased heart function, and heart attack. Symptoms may be:
- Sudden weight gain.
- Swelling in your ankles or legs.
- Chest pain or pressure.
- Pain in your left arm, back, or jaw.
- Sweating.
- Shortness of breath.
- Clammy skin.
- Nausea.
- Dizziness or lightheadedness.
If you have any of these symptoms, call 911.
Heart issues may be worse if this medication is given with anthracyclines or if anthracyclines are given after you are treated with this medication.
Lung Inflammation (Pneumonitis/Interstitial Lung Disease)
This medication can cause inflammation (swelling and irritation) of your lungs, called pneumonitis. It can also cause scarring of your lungs, called interstitial lung disease. If you have any new or worsening symptoms, like shortness of breath, cough (with or without mucous), fever, or chest pain, call your provider right away. If you are finding it hard to breathe, call 911 right away.
Administration-Related Reactions
The injection site can become red or painful. You may experience chills, fever, dizziness, nausea, rash, flushing, vomiting, and diarrhea. Medications such as acetaminophen and/or diphenhydramine may be given to lessen the reactions.
More serious reactions can occur but are rare. Symptoms of a serious reaction include shortness of breath, wheezing, low blood pressure, and an increase in heart rate. Your provider will decide if it is safe to continue treatment. Tell your provider right away if you develop any concerning symptoms during your injection.
Diarrhea
Diarrhea is when you pass three or more stools in a day. Your providers can suggest medications to relieve diarrhea. Do not take any medications to manage your diarrhea without talking to your provider first, as your stool may need to be tested. To manage it, try eating foods that are low in fiber and bland, like white rice and boiled or baked chicken. Try not to eat raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is a type of fiber found in some foods that helps absorb (soak up) fluid. Foods high in soluble fiber are applesauce, bananas (ripe), canned fruit, oranges, boiled potatoes, white rice, foods made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Stay hydrated by drinking 8 to 10 glasses of non-alcoholic, non-caffeinated fluid each day.
Nausea and/or Vomiting
Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty foods and spicy or acidic foods, like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.
Call your providers if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.
Fatigue
Fatigue can cause exhaustion, feeling worn out and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.
Muscle or Joint Pain/Aches and Headache
You may have joint or muscle pain/aches and headaches while taking this medication. Your provider can recommend medications and other ways to help relieve your pain.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) help your body fight infection. While you are having treatment for cancer, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips for preventing infection:
- Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
- When working outside, wear clothes that protect you, like long pants and gloves.
- Do not handle pet waste.
- Keep all cuts and scratches clean.
- Shower or bathe daily.
- Brush your teeth at least twice a day.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your providers before scheduling dental appointments or procedures.
- Ask your providers before you or someone you live with has any vaccines.
Reproductive Concerns
There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. Talk with your provider about what kind of birth control is safest for you and your partner.
If you can become pregnant, you will need to use effective birth control during treatment and for 7 months after the last dose of this medication, even if your menstrual cycle has stopped or changed. If you become pregnant during treatment or within the 7 months after your last dose, contact your provider right away. The company that makes this drug has a pregnancy pharmacovigilance program and should be contacted by either you or your provider if you become pregnant. You should consult with your provider before breastfeeding while receiving this medication and for 7 months after you finish treatment.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) help your body fight infection. While you are having treatment for cancer, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips for preventing infection:
- Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
- When working outside, wear clothes that protect you, like long pants and gloves.
- Do not handle pet waste.
- Keep all cuts and scratches clean.
- Shower or bathe daily.
- Brush your teeth at least twice a day.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your providers before scheduling dental appointments or procedures.
- Ask your providers before you or someone you live with has any vaccines.