Herceptin (Trastuzumab) for Breast Cancer

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Herceptin (trastuzumab) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat adults with HER2-overexpressing breast cancer.

What Members Say

MHT logo These insights are based on 8,822 comments about Herceptin from MyBCTeam members. These are the experiences of a small number of individuals and are not meant to be medical advice.

Benefits:

Herceptin often feels easier than combination chemotherapy once chemo drugs end.
Infusions often become shorter and more manageable during Herceptin-only treatment.
Weekly or every-three-week dosing can fit into a long-term treatment routine.

Considerations:

Heart problems, including reduced heart function, require regular echocardiograms or MUGA scans.
Infusion reactions can happen, especially with the first dose.
Fatigue, diarrhea, nausea, headache, cough, and muscle aches can still occur.

How Herceptin Works and How It’s Taken

Herceptin is a type of medicine called a human epidermal growth factor receptor 2 (HER2) blocker. HER2 is a protein found in high amounts on some cancer cells. Herceptin attaches to HER2 and may help slow the growth of cancer cells that overexpress this protein.

Herceptin may also help the body’s immune system attack HER2-overexpressing cancer cells. In breast cancer, targeting HER2 may help manage cancer growth in tumors that overexpress HER2.

Doctors prescribe Herceptin when adults have certain types of HER2-overexpressing breast cancer. Depending on the type and stage of breast cancer, it may be used:

As part of a treatment plan for early-stage breast cancer with chemotherapy that includes doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel
With docetaxel and carboplatin for certain individuals with early-stage breast cancer
By itself after anthracycline-based chemotherapy for certain individuals with early-stage breast cancer
With paclitaxel as the first treatment for HER2-overexpressing breast cancer that has spread to other parts of the body
By itself for HER2-overexpressing breast cancer that has spread after one or more chemotherapy treatments

The cancer must show HER2 protein overexpression or HER2 gene amplification using an FDA-approved test.

Herceptin is given as an intravenous (IV) infusion. Depending on the treatment plan, it may be given once a week or once every three weeks.

For early-stage breast cancer, treatment is usually given for a total of 52 weeks. Treatment beyond one year is not recommended. For metastatic breast cancer, treatment continues until the cancer gets worse or side effects become unacceptable.

Typical Dosing for Breast Cancer

The recommended dose of Herceptin for breast cancer depends on whether it is used for early-stage breast cancer or metastatic breast cancer.

Early-stage breast cancer dosing:

When Herceptin is given during chemotherapy with paclitaxel or docetaxel:

Starting dose — 4 milligrams per kilogram given as an IV infusion over 90 minutes
Weekly dose during chemotherapy — 2 milligrams per kilogram once weekly during chemotherapy
Dose after weekly treatment — 6 milligrams per kilogram every three weeks, starting one week after the last weekly dose

When Herceptin is used by itself after anthracycline-based chemotherapy:

Starting dose — 8 milligrams per kilogram given as an IV infusion over 90 minutes
Ongoing dose — 6 milligrams per kilogram every three weeks
Treatment length — A total of 52 weeks

Metastatic breast cancer dosing:

For HER2-overexpressing breast cancer that has spread:

Starting dose — 4 milligrams per kilogram given as an IV infusion over 90 minutes
Ongoing dose — 2 milligrams per kilogram once weekly as an IV infusion
Treatment length — Until the cancer gets worse

Doctors may slow the infusion rate, interrupt treatment, withhold treatment, or stop treatment for certain serious side effects or if side effects are too hard to manage.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Herceptin

MHT logo These insights are based on 8,822 comments about Herceptin from MyBCTeam members.

Members who use Herceptin often say the targeted-therapy phase feels easier than chemo, but they still stress the importance of paying attention to side effects, heart monitoring, and day-to-day recovery. Many also encourage staying in close contact with your care team, asking questions, and preparing for the practical side of long treatment schedules.

1

Keep up with heart monitoring and ask about symptoms like swelling or shortness of breath.
“The only issue I have heard is potential heart issues, but they monitor you prior to starting with an echo, and then you have regular echos to determine if it’s affecting your heart.”
2

Ask questions and write things down for appointments.
“I’m surprised also. I met with the nurses a few days before I began. They gave me a binder filled with papers of what to expect and what I should know. Please don’t hesitate to ask anything anytime.”
3

Expect Herceptin-only treatment to feel easier for many people.
“The Herceptin only was soooo much easier!! Where chemo was usually 8 a.m. to 3 p.m. for me, Herceptin was usually in and out in an hour!!”

Connect with others who understand life with breast cancer. Join MyBCTeam for free.

Herceptin Side Effects

In clinical trials of Herceptin for HER2-overexpressing breast cancer in adults, the most common side effects differed between adjuvant breast cancer and metastatic breast cancer.

For adjuvant breast cancer, these side effects include:

Headache
Diarrhea
Nausea
Vomiting
Chills
Nasopharyngitis (common cold-like symptoms)
Joint pain
Fever
Peripheral edema (swelling in the arms, legs, hands, or feet)
Cough
Back pain
Fatigue or weakness
Myalgia (muscle pain)
Dyspnea (shortness of breath)
Rash

For metastatic breast cancer, these side effects include:

Fever
Chills
Headache
Infection
Cough
Rash
Insomnia (trouble sleeping)
Congestive heart failure
Nausea
Diarrhea
Vomiting
Fatigue or weakness
Pain
Dyspnea
Dizziness
Rhinitis (runny nose)
Pharyngitis (sore throat)
Peripheral edema
Anorexia (loss of appetite)
Neutropenia (low levels of neutrophils, a type of white blood cell)
Anemia (low red blood cell levels)
Myalgia

Serious Side Effects and Warnings

Herceptin can cause serious side effects that may require immediate medical attention. These include:

Cardiomyopathy — Heart problems can include weakened heart function, heart failure, abnormal heart rhythm, high blood pressure, and cardiac death.
Severe infusion reactions — These can be severe or life-threatening and may happen during or within 24 hours after treatment.
Pulmonary toxicity — Serious lung problems can include interstitial pneumonitis, pulmonary infiltrates, pleural effusions, noncardiogenic pulmonary edema, pulmonary insufficiency and hypoxia, acute respiratory distress syndrome, and pulmonary fibrosis.
Embryo-fetal toxicity — Exposure during pregnancy can cause low amniotic fluid, lung problems, skeletal abnormalities, and neonatal death.
Exacerbation of chemotherapy-induced neutropenia — Severe low white blood cell counts can increase the risk of serious infection.

Get medical help right away if you think you are having a serious reaction.

How To Save on Herceptin

Genentech, the manufacturer of Herceptin, offers the Genentech Oncology Co-Pay Assistance Program. Eligible people with commercial insurance may pay as little as $0 per treatment for Herceptin. The program is not available to people whose prescriptions are reimbursed under federal, state, or government-funded insurance programs, including Medicare, Medicaid, and TRICARE.

The Genentech Oncology Co-Pay Assistance Program is part of Genentech Access Solutions, which can help people understand their insurance coverage and out-of-pocket costs. The program may also work with a person’s doctor’s office, health insurance plan, and specialty pharmacy to help them access their medication.

To learn more, visit the Herceptin financial assistance page, or call 877-436-3683. Additional information is available through Genentech Patient Support Services.

What To Know Before Taking Herceptin

Before starting Herceptin, your doctor will check for:

Heart function, including left ventricular ejection fraction (LVEF)
Whether your tumor has HER2 protein overexpression or HER2 gene amplification
Pregnancy status if you can become pregnant

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

Herceptin is also FDA-approved to treat adults with HER2-overexpressing metastatic gastric cancer or gastroesophageal junction adenocarcinoma.

If you miss a Herceptin dose by one week or less, receive the missed dose as soon as possible. Do not wait until your next scheduled treatment.

If you miss a dose by more than one week, your healthcare provider may give a higher “re-loading” dose before you return to your regular dosing schedule. Talk with your doctor if you miss an appointment for a Herceptin infusion.

Herceptin can harm your baby if you are pregnant. Your doctor should verify your pregnancy status before you start treatment.

Females who can become pregnant should use effective birth control during treatment and for seven months after their last dose of Herceptin.

It is not known whether Herceptin passes into human breast milk. Because Herceptin may stay in the body after treatment ends, consider the seven-month washout period before breastfeeding.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Herceptin?

In studies of HER2-overexpressing early breast cancer, people who received Herceptin were more likely to live without their cancer coming back or getting worse than people who did not receive Herceptin.

In two large studies, Herceptin improved disease-free survival and overall survival. Disease-free survival means living without the cancer coming back or getting worse. Overall survival means living longer.

Herceptin improved disease-free survival (hazard ratio 0.48) and overall survival (hazard ratio 0.64). After a median follow-up of 8.3 years, people who received Herceptin were more likely to live without their cancer coming back and were more likely to live longer than those who did not receive Herceptin.

In another study, one year of Herceptin improved disease-free survival compared with observation alone (hazard ratio 0.54).

In metastatic breast cancer, people who received Herceptin plus chemotherapy lived longer than people who received chemotherapy alone. Median survival was 25.1 months with Herceptin plus chemotherapy compared with 20.3 months with chemotherapy alone.

How often is Herceptin taken for breast cancer?

For early breast cancer, Herceptin may be given weekly during certain chemotherapy regimens and then every three weeks afterward, for a total of 52 weeks of therapy. It may also be given every three weeks as a single agent after completion of certain chemotherapy. For metastatic breast cancer, Herceptin is usually given once a week until the cancer gets worse.

What medications should be avoided while taking Herceptin?

The Herceptin prescribing information does not list any medications that must be completely avoided during treatment.

However, anthracycline chemotherapy medicines, such as doxorubicin, may increase the risk of heart problems when used after Herceptin treatment. Because Herceptin can stay in the body for several months, anthracycline-based therapy should be avoided for up to seven months after the last dose when possible.

Be sure to tell your healthcare provider about all prescription medicines, over-the-counter medicines, vitamins, and herbal supplements you take before starting Herceptin.