monoclonal antibodies

trastuzumab

major monocloal antibody

trastuzumab

therapeutic use

Treats a specific type of metastatic breast cancer (tumors with human epidermal growth factor receptor 2 [HER2], which includes up to 30% of metastatic breast cancers)

adverse effects

• Allergic reaction (usually occurs with first dose or within 12 hr of that infusion): bronchospasm with wheezing, hypotension, shortness of breath, urticaria

• Infusion reaction, chills, fever, flu-like manifestations during infusion (less significant manifestations may occur with subsequent treatments) • Cardiac findings: heart failure, dysrhythmias

• CNS manifestations: headache, insomnia, dizziness, paresthesias

• Gastrointestinal manifestations: nausea, vomiting, diarrhea

interventions

• Stop infusion if adverse reactions develop.

• Prepare to treat with epinephrine or other medications as prescribed. • Monitor for flu-like manifestations and monitor temperature; report to provider.

• Monitor cardiac status at baseline and frequently during course of treatment, especially in clients who have experienced previous cardiac dysfunction.

• Monitor for manifestations of heart failure and dysrhythmias.

• Monitor and report CNS manifestations to provider.

• Monitor for gastrointestinal manifestations.

• Treat nausea/vomiting during infusion with antiemetics, as needed.

administration

• IV

• Infuse weekly at a dosage based on client’s weight; first week begins with a larger loading dose.

• DO NOT mix dose with dextrose solutions.

client instructions

• Immediately report rash, shortness of breath, wheezing to staff.

• Report chills, flu-like manifestations that occur during an infusion of trastuzumab.

• Report shortness of breath, edema of extremities, palpitations to provider. • Report persistent headache, insomnia, dizziness, numbness, and tingling of extremities.

• Avoid hazardous activities, such as driving, until effects are known.

• Report persistent nausea, vomiting, diarrhea to provider.

contraindications

• Pregnancy risk category D, no lactation within 6 months after treatment with trastuzumab

• Concurrent radiation or administration with anthracycline anticancer antibiotics, such as doxorubicin

precautions

• Cardiac or pulmonary disease

• Previous administration of anticancer medications that are cardiotoxic, such as doxorubicin

interactions

• Paclitaxel increases risk for trastuzumab toxicity.

• Concurrent anthracycline therapy may increase risk of cardiotoxicity