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MECHANISM


Herceptin is a type of monoclonal antibody which targeting the HER2, provoke a resistant mediate reaction which causes disguise and down regulation of HER2. HER2 pathway is specific for cell proliferation, joining of Transtuzumab to the site of HER2 causes prevention of this activity. This joining leads to antibody mediated and leads to HER2 positive cells break down. Herceptin is a intermediary of anti-body dependent cellular cytotoxicity. Distribution: Volume of distribution: 44 mL/kg as trastuzumab; 3.13 L as trastuzumab emtansine. Metabolism: As trastuzumab emtansine: which Undergoes deconjugation and catabolism through proteolysis in cellular lysosomes. Excretion: Terminal Elimination half-life is 6 days (weekly dosing); 16 days (3 weekly regimen); approx 4 days as trastuzumab emtansine. Elimination of drug includes clearance of IgG through the reticuloendothelial system.

DOSAGE

Adjuvant regimen for HER2 over expressing Breast cancer:

52 weeks of treatment total schedules as follows: Combination With paclitaxel or docetaxel ,over a 90 minutes, 4mg/kg IV then over 30 minutes , 2mg /kg for 12 weeks or combination with Carboplatin/ docetaxel for 18 weeks one week following the last weekly dose. Over 30 to 90 minutes, 6mg/kg IV for every 3 weeks.

Esophageal carcinoma or gastric cancer for adult dose:

8mg/kg IV over 90 minutes as initial dose 6mg/kg IV over 30 to 90 minutes for every 3 weeks as maintenance dose Duration of therapy for initial and maintenance dose until disease progression.

Breast cancer Metastatic HER2-Overexpressing:

Over a 90 minutes, 4mg/kg alone or with combination of paclitaxel in initial dose. Over 30 minutes, 2mg /kg once in a week for maintenance dose. Duration of therapy for initial and maintenance dose until disease progression.


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Administration


Herceptin is administer into vein through IV infusion over 90 minutes Do not administer IV push or bolus. Duration of Herceptin is administrated in once every week or every 3 weeks. Before starting treatment, patients should undergo biopsy to check Herceptin is the right regimen The infusion solution should be compatible to polyvinyl chloride or polyethylene bags. After dilution, the infusion bag should be stored at 2oC to 8oC for not more than 24 hours before use.

Brand : Herceptin
Ingredients : Trastuzumab
Strength : 440mg
Manufactured : Roche
Package : two vials in a carton, one vial containing drug Transtuzumab & one vial containing bacteriostatic water

The most common adverse effects

Cardiomyopathy Infusion reactions Embryo fetal toxicity Pulmonary toxicity Chemotherapy induced neutropenia

The most common side effects

Hypertension Influenza Dyspnae URI Rhinitis Pharyngolaryngeal pain Sinusitis Epitasis Pulmonary hypertension Dizziness Decrease LVEF Palpitations Arrhythmia Cardiac failure Cough Interstitial pneumonitis Diarrhea/constipation Nausea, vomiting Dyspepsia Autoimmune thyroiditis Neutropenia Hypokalemia Anemia Thrombocytopenia Febrile neutropenia Renal failure Abdominal pain Arthralgia Back pain Bone pain Headache Paresthesia 1Rash Nail disorders Pruritus Pyrexia Chills Edema Asthenia Sudden death

Embryo fetal damage

Herceptin is contraindicated to pregnancy period. Avoid becoming pregnancy during this therapy. Use efficient contraceptives during treatment

Cardiomyopathy

Herceptin receiving patients have increased risk of exposing to cardiac disorders. Provide alternative therapy management In serious condition, treatment should be discontinue

Pulmonary toxicity

Some serious fatal cases of pulmonary toxicity occur during Herceptin treatment.

Infusion reactions

During Herceptin treatment some life threatening infusion reactions are produced. In serious infusion reactions, Stop the Herceptin treatment permanently. Patient should be treated with premedication before starting the infusion to overcome the such problem, During Herceptin treatment.use with Caution.

Therapy induced neutropenia

Higher incidence of neutropenia occurs during Herceptin treatment.



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DRUG- DRUG INTERACTION

In some phenomenal condition, patient should get anthracycline, in that situation patient’s cardiac function should be checked carefully with regular intervals. Do not take anthracycline treatment for 7 months after stopping the Herceptin treatment. Herceptin interaction with anthracycline after ending of Herceptin treatment may have a chance of getting cardiac problem. This side effects occur because of Transtuzumab great disaster period is depends on population PK analysis.

CONTRAINDICATIONS

Probably no contraindicated occurs. The patients are contraindicated to the component present in the Herceptin , Hence Hypersensitivity reactions are occurs. Infusion reactions are produced.

Missed dose

If missed cycles of Herceptin treatment by one week or less, then the repeated maintenance dose (weekly schedule: 2mg/kg; 3 weekly schedule: 6mg/kg) administer as soon as probably. Until the next planned cycle the patient does not take interval. Consecutive Herceptin maintenance dose should be taken in 7 days or 21 days next confer to the weekly or 3 weekly schedules. If patient missed to take Herceptin dose by higher than one week, then resume with re-storing dose of Herceptin such as weekly schedule is 4mg/kg; 3 weekly schedules is 8mg/kg should be administered over period of 90 minutes.






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