Herceptin injection (trastuzumab)

What is Herceptin?

Herceptin is a brand-name prescription drug that’s FDA-approved as a treatment for:

• HER2-positive breast cancer (the cancer cells have abnormally high levels of a protein called HER2). For this purpose, Herceptin is used as an adjuvant treatment (therapy used to prevent cancer from returning).
• HER2-positive breast cancer that’s metastatic (has spread to other parts of the body)
• HER2-positive gastric (stomach) cancer or gastroesophageal junction adenocarcinoma that’s metastatic

When used to treat breast cancer, Herceptin may be used on its own or with other therapies. When used to treat stomach cancer, Herceptin is used with other cancer drugs.

Herceptin is approved for use in adults only. It’s not known if it’s safe or effective for use in children.

Herceptin is a HER2-targeted therapy. It binds to HER2 receptors (docking stations) on cancer cells and prevents the cells from growing.

Herceptin is given by infusion (an injection into your vein that’s slowly dripped in over time). It should only be given by a healthcare professional.

What’s Herceptin Hylecta?

Herceptin Hylecta is a combination of the drugs trastuzumab and hyaluronidase. It’s FDA-approved for the treatment of breast cancer. It’s given by subcutaneous injection (under the skin). It can’t be given by infusion like Herceptin can.

For more information about how Herceptin and Herceptin Hylecta are similar and different, see the “Herceptin vs. Herceptin Hylecta” section.

Effectiveness

For information about Herceptin’s effectiveness for treating different conditions, see the “Herceptin uses” section.

Herceptin generic or biosimilar

Herceptin is a brand-name biologic medication. It is also available in certain biosimilar forms.

Biologic drugs, such as Herceptin, are made from living cells. These medications are sometimes available as biosimilars, which act as “generic” versions. (Generics are sometimes available for brand-name medications that are not made from living cells.)

Biosimilars are considered to be just as safe and effective as their parent drug. And like generics, biosimilars tend to cost less than brand-name medications.

Herceptin side effects

Herceptin can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Herceptin. These lists do not include all possible side effects.

Side effects for Herceptin Hylecta may differ from those seen with Herceptin. Side effects may also vary depending on the condition that Herceptin or Herceptin Hylecta is being used to treat.

For more information on the possible side effects of Herceptin, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may be bothersome.

You can also see this detailed article about Herceptin’s potential side effects.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs they have approved. If you would like to report to the FDA a side effect you’ve had with Herceptin, you can do so through MedWatch.

Mild side effects

In studies, how often side effects occurred depended on the condition Herceptin was being used to treat.

For breast cancer

For breast cancer treatment, the more common* mild side effects of Herceptin can include:

• headache
• diarrhea
• nausea
• infection (skin, urinary tract, or upper respiratory)
• insomnia (trouble sleeping)
• cough
• rash
• fluid retention (swelling)
• hot flashes
• back, joint, or abdominal (belly) pain
• fever
• chills
• depression (See “Side effect details” below.)

For breast cancer treatment, the less common** mild side effects of Herceptin can include:

• flu (fever, chills, cough)
• shortness of breath
• sinusitis (swelling of the sinuses)
• vomiting
• constipation
• pain in upper abdomen (belly)
• muscle aches, pain, or spasms
• bone pain
• tickling or burning feeling on the skin
• rash

For gastric cancer

For gastric (stomach) cancer treatment, the mild side effects*** of Herceptin can include:

• fatigue (lack of energy)
• stomatitis (swelling of the lips, mouth, inside of cheeks, and throat)
• weight loss
• upper respiratory infection (cough, runny nose, sore throat)
• fever
• common cold
• change of taste (having decreased or no taste)

* Occurred in 5% or more of people taking Herceptin for breast cancer in clinical studies
** Occurred in less than 5% of people taking Herceptin for breast cancer in clinical studies
*** All occurred in more than 5% of people taking Herceptin to treat gastric cancer in clinical studies

If you have side effects that are severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• Anemia (low level of red blood cells). Symptoms can include:
  • fatigue (lack of energy)
  • dizziness
  • pale-looking skin or gums
• Thrombocytopenia (low level of platelets, a type of blood cell). Symptoms can include:
  • bruising easily (red, purple, or brown bruises)
  • bleeding from wounds that lasts for a long time or doesn’t stop on its own
  • nosebleeds
• Neutropenia (low level of white blood cells). Symptoms can include:
  • infections, such as pneumonia, sinus infections, or ear infections
  • fever
  • sores that take longer than usual to heal
• Blood clot. Symptoms can include:
  • pain, swelling, or discoloration in the arms or legs
  • loss of strength in one arm or leg
  • shortness of breath
  • chest pain
• Kidney problems. Symptoms can include:
  • fluid retention (swelling)
  • dizziness
  • dark urine
  • itching
  • low urine output
• Tumor lysis syndrome (when cancer cells release harmful chemicals into your blood). Symptoms can include:
  • nausea
  • fatigue
  • muscle cramps
  • abnormal heart rhythm
  • acute kidney failure
• Neuropathy (nerve damage). Symptoms can include:
  • numbness
  • tingling
  • pain

Other serious side effects are explained below in “Side effect details.” These include:

• allergic reaction
• heart problems*
• reaction to the infusion or lung problems*

* Herceptin has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). For more information, see the “FDA warnings” section at the beginning of this article.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on several of the side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Herceptin. Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

In one study of people taking Herceptin for adjuvant treatment of breast cancer (therapy used to prevent cancer from returning), allergic reactions occurred in 0.6% of people. In comparison, 0.06% of people not taking Herceptin as part of their treatment had allergic reactions.

Call your doctor right away if you have a severe allergic reaction to Herceptin. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Heart problems

Some people may have heart-related side effects while taking Herceptin.

In clinical studies, heart-related side effects occurred more often in people taking both Herceptin and standard chemotherapy treatment (medication-based treatment that’s well established within the field) compared to standard treatment alone. Standard treatment varied depending on the specific study and the type of condition being treated.

Symptoms of heart problems can include:

• rapid weight gain
• changes in blood pressure
• racing heart
• fatigue (lack of energy)
• fluid retention (swelling)
• trouble breathing
• heart failure
• changes in heart rhythm

If you have chest pain, dizziness, weakness, racing heart, fluid retention or swelling, rapid weight gain, fainting, or palpitations contact your doctor immediately. If you feel like you’re having a medical emergency, call 911.

Reaction to the infusion or lung problems

Herceptin is given by infusion (an injection into your vein that’s slowly dripped in over time). Some people taking Herceptin may have a reaction to the infusion. This can affect many different systems in the body, including the lungs.

Symptoms of a reaction to the infusion can include:

• shortness of breath
• chills
• fever
• changes in blood pressure
• rash
• nausea

Symptoms of lung problems can include:

• shortness of breath
• cough
• chest pain or tightness

Some symptoms are uncomfortable but not severe. Many can be managed by the use of add-on medications like acetaminophen (Tylenol), diphenhydramine (Benadryl), and meperidine (Demerol).

In clinical studies, reactions to the infusion were severe in 1% to 9% of people taking Herceptin, depending on whether they took Herceptin alone or with chemotherapy. During the studies, less than 1% of people using Herceptin had to stop taking the drug because of a reaction to the infusion.

If you experience changes in blood pressure, shortness of breath, or other severe infusion-related symptoms (such as allergic reaction) tell your doctor immediately.

Back and muscle pain

Taking Herceptin may cause pain in the muscles or back. It could also cause pain in the upper abdomen (belly), or joints. In clinical studies, the following types of pain were reported in people taking Herceptin.

• muscle pain or spasms: 3% to 4%
• back pain: 5% to 34%
• abdominal pain: 2% to 34%
• joint pain: 6% to 37%

Talk with your doctor if you have severe pain either during your infusion or between infusions. They may prescribe something to treat your pain or consider other treatment options for you.

Depression

Some people taking Herceptin may experience depression. In clinical trials, depression was reported in 6% to 20% of people taking Herceptin for breast cancer.

Symptoms of depression can include:

• feeling low
• little or no interest in activities you once enjoyed
• unintentional weight loss or gain
• sleeping too much or not enough
• feeling agitated or restless

Fatigue (lack of energy) is also a common side effect of Herceptin. Fatigue can contribute to depression in some people.

Receiving a cancer diagnosis can cause a variety of emotions. For some people, it can lead to depression, anxiety, or other mental health conditions. Talk with your doctor if you have thoughts of harming yourself or others, or if you feel like you’re losing hope. They can suggest ways to help you manage depression as you receive treatment for your cancer.

Harm to a fetus

Becoming pregnant while taking Herceptin or within 7 months of stopping Herceptin treatment can cause fetal harm or death. This is because Herceptin lowers the amount of amniotic fluid in the uterus. It’s important to use birth control to help prevent pregnancy during Herceptin treatment and for 7 months after stopping treatment.

Herceptin and Perjeta

Perjeta (pertuzumab) is FDA-approved for use with Herceptin and docetaxel (Taxotere) to treat metastatic breast cancer. It’s also approved for use with Herceptin and chemotherapy for the treatment of early breast cancer.

In one study, about 39% of people who took Herceptin, Perjeta, and docetaxel for 12 weeks had complete responses (meaning no cancer cells in their breasts or lymph nodes). In comparison, about 22% of those taking Herceptin and docetaxel only had complete responses. People in both groups also had surgery to remove the cancer, followed by chemotherapy.

Herceptin use with other drugs

Herceptin is often used with other medications, including chemotherapy or other targeted therapies, to treat breast cancer or gastric cancer.

Herceptin may be used at the same time as the following drugs, or after you’ve completed treatment with them:

• capecitabine (Xeloda)
• carboplatin
• cisplatin
• cyclophosphamide
• docetaxel (Taxotere)
• fluorouracil
• lapatinib (Tykerb)
• paclitaxel (Abraxane)
• tamoxifen (Soltamox)
• vinorelbine
• epirubicin (Ellence)
• doxorubicin (Doxil)*

* This drug is an anthracycline. Herceptin is approved for use with this drug. However, Herceptin has a boxed warning stating that people taking Herceptin with anthracyclines may have a higher risk for heart problems. (See the “FDA warnings” section at the beginning of this article.)

Herceptin interactions

Herceptin can interact with several other medications. Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Herceptin and other medications

Below is a list of medications that can interact with Herceptin. This list does not contain all drugs that may interact with Herceptin.

Before taking Herceptin, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Herceptin and anthracyclines

Anthracyclines are a class of drugs used to treat cancer. Examples include doxorubicin (Doxil), epirubicin (Ellence), and daunorubicin (Cerubidine). Taking anthracyclines within 7 months of your last Herceptin dose can raise your risk for heart problems.

If your doctor decides anthracyclines are the best option for you, they will monitor your heart during your treatment.

Herceptin and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Herceptin. However, you should still check with your doctor or pharmacist before using any of these products while taking Herceptin.

Herceptin and foods

There aren’t any foods that have been specifically reported to interact with Herceptin. If you have any questions about eating certain foods with this drug, talk with your doctor.

Herceptin dosage

The Herceptin dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re using Herceptin to treat
• other medications you’re taking or have taken to treat your condition
• your weight (doses are determined by your weight in kilograms, such as 4 mg/kg)

The following information describes dosages that are commonly used or recommended. However, be sure to follow the dosing frequency recommendations your doctor has for you. Your doctor will determine the best dosage to fit your needs. Herceptin will only be given in a healthcare setting by a healthcare professional.

For more information, you can also see this in-depth article about Herceptin’s dosages.

Drug forms and strengths

Herceptin is given by infusion (an injection into your vein that’s slowly dripped in over time). It should only be given by a healthcare professional. Herceptin is available in two strengths:

• 150-mg powder in a single-dose vial that’s mixed with a liquid solution
• 420-mg powder in a multiple-dose vial that’s mixed with a liquid solution

Dosage for adjuvant treatment of breast cancer

There are two main dosage schedules for Herceptin when it’s used as an adjuvant treatment (therapy used to prevent cancer from returning). Both options last 52 weeks. Your Herceptin dosage schedule will depend on whether you take Herceptin at the same time as other treatments (such as chemotherapy) or whether you take it after completing other treatments.

Dosage if you’re currently taking other treatments

Herceptin may be given with other treatments, such as paclitaxel (Abraxane), docetaxel (Taxotere), or docetaxel/carboplatin. In this case, a loading dose of 4 mg per kg of body weight is given as an infusion over 90 minutes. (Loading doses are used to increase the level of the drug in your body right away.)

Next, the Herceptin dosage is 2 mg/kg given as an infusion over 30 minutes every week during chemotherapy for 12 weeks (with paclitaxel or docetaxel) or 18 weeks (with docetaxel/carboplatin).

Starting 1 week later, the Herceptin dosage changes to 6 mg/kg given as an infusion over 30 to 90 minutes every 3 weeks.

Dosage if you’ve completed other treatments

Herceptin may be given by itself after you’ve completed other treatments (such as chemotherapy). In this case, the loading dose is 8 mg/kg given as an infusion over 90 minutes.

After that, the Herceptin dosage is 6 mg/kg given as an infusion over 30 to 90 minutes every 3 weeks.

Dosage for metastatic breast cancer

If you take Herceptin for metastatic breast cancer (whether alone or with paclitaxel), the loading dose is 4 mg per kg of body weight given as a 90-minute infusion. Then the dosage is 2 mg/kg given as a 30-minute infusion given once a week for as long as your doctor recommends it.

Dosage for gastric cancer

If you take Herceptin for gastric (stomach) cancer, the loading dose is 8 mg per kg of body weight given as a 90-minute infusion. Then the dosage is 6 mg/kg given as an infusion over 30 to 90 minutes every 3 weeks for as long as your doctor recommends it.

What if I miss a dose?

To help make sure you don’t miss a dose, try setting a reminder on your phone for your infusion appointments.

If you miss a dose of Herceptin by 1 week or less, your usual dose should be given to you as soon as possible rather than waiting until the next planned dose. You’ll get your next dose either 1 week or 3 weeks from the date you get this dose, depending on your dosage schedule.

If you miss a dose of Herceptin by more than 1 week, another loading dose of Herceptin should be given as a 90-minute infusion as soon as possible. You’ll get your next dose either 1 week or 3 weeks from the date you get this loading dose, depending on your dosage schedule.

Will I need to use this drug long term?

Herceptin may be used as a long-term treatment. When used as adjuvant treatment of breast cancer (therapy used to prevent cancer from returning), Herceptin is typically used for 1 year. When used to treat metastatic breast or gastric (stomach) cancer, Herceptin is typically taken until your cancer worsens (if this happens). Your doctor will determine how long you should take Herceptin.

Herceptin uses

The Food and Drug Administration (FDA) approves prescription drugs such as Herceptin to treat certain conditions. Herceptin may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Herceptin for metastatic breast cancer

Herceptin is FDA-approved for the treatment of metastatic breast cancer. “Metastatic” means the cancer has spread to other areas of the body. Metastatic breast cancer is also called stage 4 breast cancer.

Effectiveness for metastatic breast cancer

A study of females* with metastatic HER2-positive breast cancer compared chemotherapy alone (for example, doxorubicin or epirubicin plus cyclophosphamide) to chemotherapy plus Herceptin. Those who took Herceptin had better outcomes than those who did not take Herceptin, including slower progression (worsening) of their breast cancer.

* Sex and gender exist on spectrums. Use of the term “females” in this article refers to sex assigned at birth.

Herceptin for adjuvant treatment of breast cancer

Herceptin is FDA approved for the adjuvant treatment of breast cancer. For this purpose, Herceptin is used to lower the risk of cancer coming back after treatment such as radiation or surgery.

Effectiveness for adjuvant breast cancer

Studies of females* with HER2-positive breast cancer compared standard chemotherapy treatment (doxorubicin and cyclophosphamide followed by paclitaxel) to treatment that included Herceptin and paclitaxel. The study looked at survival rates after about 8 years of follow-up. (In clinical studies, the term “survival rate” is used to show how many people are still living at a certain point in time.)

The survival rate for the treatment with Herceptin and paclitaxel was about 87% compared to about 79% with the standard treatment approach.

Another study found that 2 years of treatment with Herceptin did not lead to more benefits than 1 year of treatment with Herceptin.

* Sex and gender exist on spectrums. Use of the term “females” in this article refers to sex assigned at birth.

Herceptin for gastric cancer

Herceptin is FDA-approved for the treatment of gastric (stomach) cancer. It’s also FDA-approved to treat gastroesophageal junction adenocarcinoma. This is a form of cancer that develops where your stomach meets your esophagus (the tube connecting your mouth and stomach). Because it’s similar to cancer that forms in your stomach, it’s often treated in the same ways as gastric cancer.

Effectiveness for gastric cancer

A study of people with metastatic stomach cancer or gastroesophageal junction adenocarcinoma compared standard chemotherapy treatment (cisplatin and capecitabine or 5-fluorouracil) to standard chemotherapy treatment plus Herceptin. Survival rates were better when Herceptin was included in the treatment.

Off-label uses for Herceptin

In addition to the uses listed above, Herceptin may be used off-label. Off-label drug use is when a drug that’s approved for one use is used for a different one that’s not approved. Below are examples of off-label uses for Herceptin.

Herceptin for colon cancer

Herceptin has been used off-label for the treatment of colon cancer. An ongoing study is evaluating the effectiveness of Herceptin with pertuzumab (Perjeta) in 57 people with metastatic HER2-positive colon cancer that was resistant to other treatments.

Of the people in the study, 32% percent had their cancer go away completely or partially.

More research is needed to understand Herceptin’s exact role in the treatment of colon cancer.

Herceptin for lung cancer

Herceptin has been used off-label for the treatment of lung cancer. A study of people with non-small cell lung cancer and HER2 mutations looked at the effectiveness of Herceptin and other HER2 target medications. Of the people taking HER2-targeted treatment (including Herceptin), 51% had their cancer go away completely or partially. In comparison, 44% of people taking standard chemotherapy had their cancer go away completely or partially.

More research is needed to understand Herceptin’s place in lung cancer treatment.

Herceptin for neoadjuvant breast cancer

Herceptin has been used as neoadjuvant (presurgery) treatment for breast cancer. A study compared treatment with Herceptin plus traditional chemotherapy before surgery to traditional chemotherapy before surgery. Both groups then received Herceptin after surgery.

Of those taking Herceptin before surgery, 47% had complete responses (no cancer cells in their breasts or lymph nodes). In comparison, 5% of those who had traditional chemotherapy had complete responses.

More research is needed to define Herceptin’s place in presurgery treatment of breast cancer.

Alternatives to Herceptin

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Herceptin, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternatives for the treatment of HER2-overexpressing breast cancer

Examples of other medications that may be used to treat breast cancer that’s HER2-overexpressing (HER2-positive) include:

• targeted therapies:
  • ado-trastuzumab emtansine (Kadcyla)
  • neratinib (Nerlynx)
  • pertuzumab (Perjeta)
  • lapatinib (Tykerb)
• chemotherapy:
  • carboplatin
  • cyclophosphamide
  • docetaxel (Taxotere)
  • doxorubicin (Doxil)
  • epirubicin (Ellence)
  • paclitaxel (Abraxane)
  • vinorelbine
• hormone therapy:
  • tamoxifen (Soltamox)

Alternatives for gastric (stomach) cancer

Examples of other drugs that may be used to treat stomach cancer include:

• capecitabine (Xeloda)
• carboplatin
• cisplatin
• docetaxel (Taxotere)
• epirubicin (Ellence)
• fluorouracil
• irinotecan (Camptosar)
• oxaliplatin (Eloxatin)
• paclitaxel (Abraxane)
• ramucirumab (Cyramza)
• trifluridine/tipiracil (Lonsurf)

Herceptin vs. Kadcyla

You may wonder how Herceptin compares with other medications that are prescribed for similar uses. Here we look at how Herceptin and Kadcyla are alike and different.

Ingredients

Herceptin contains the active drug trastuzumab. Kadcyla contains the active drug ado-trastuzumab emtansine.

Uses

Herceptin is FDA-approved for the following uses:

• treatment of HER2-positive breast cancer (the cancer cells have abnormally high levels of a protein called HER2). For this purpose, Herceptin is used as an adjuvant treatment (therapy used to prevent cancer from returning).
• treatment of HER2-positive breast cancer that’s metastatic (has spread to other parts of the body)
• treatment of HER2-positive gastric (stomach) cancer or gastroesophageal junction adenocarcinoma that’s metastatic

Kadcyla is FDA-approved for the following uses:

• treatment of HER2-positive metastatic breast cancer in people who previously received Herceptin and a taxane medication (either separately or together)
• adjuvant treatment of HER2-positive early stage breast cancer (cancer cells have not spread beyond the breast or lymph nodes in the armpits) that needs treatment after neoadjuvant (presurgery) taxane and trastuzumab treatment

Drug forms and administration

Herceptin and Kadcyla are both given by infusion (an injection into your vein that’s slowly dripped in over time). They should only be given by a healthcare professional.

Side effects and risks

Herceptin and Kadcyla have some similar side effects and others that differ. Below are examples of these side effects.

Mild side effects

These lists contain examples of mild side effects that can occur with Herceptin or with both Herceptin and Kadcyla (when taken individually).

• Can occur with Herceptin when used to treat breast cancer:
  • hot flashes
  • depression
  • flu (fever, chills, cough)
  • sinusitis (swelling of the sinuses)
• Can occur with Herceptin when used to treat gastric (stomach) cancer:
  • weight loss
  • upper respiratory tract infections (cough, runny nose, sore throat)
  • common cold
  • change of taste
  • fever
• Can occur with both Herceptin and Kadcyla:
  • fatigue (lack of energy)
  • nausea
  • back, joint, or abdominal (belly) pain
  • headache
  • diarrhea
  • stomatitis (swelling of the lips, mouth, inside of cheeks, and throat)
  • infection (skin, urinary tract, or upper respiratory)
  • insomnia (trouble sleeping)
  • cough
  • rash
  • fluid retention (swelling)

Serious side effects

These lists contain examples of serious side effects that can occur with Herceptin, with Kadcyla, or with both drugs (when taken individually).

• Can occur with Herceptin
  • blood clot
  • kidney problems
• Can occur with Kadcyla:
  • hemorrhage (internal bleeding)
  • liver problems*
• Can occur with both Herceptin and Kadcyla:
  • anemia (low level of red blood cells)
  • neutropenia (low level of white blood cells)
  • thrombocytopenia (low level of platelets, a type of blood cell)
  • neuropathy (nerve damage)
  • tumor lysis syndrome (when cancer cells release harmful chemicals into your blood)
  • allergic reaction
  • lung problems**
  • heart problems***
  • reaction to the infusion***

* Kadcyla has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA).
** Herceptin has a boxed warning for this side effect. For more information, see the “FDA warnings” section at the beginning of this article.
*** Both Herceptin and Kadcyla have boxed warnings for this side effect.

Effectiveness

Herceptin and Kadcyla have different FDA-approved uses, but they’re both used to treat breast cancer.

The use of Herceptin and Kadcyla in treating early breast cancer have been directly compared in a clinical study. After a follow-up period of about 40 months, the occurrence of invasive breast cancer or death was lower in the Kadcyla group compared to those who received Herceptin.

Costs

Herceptin and Kadcyla are both brand-name drugs. Herceptin is available in certain biosimilar forms. However, Kadcyla is not currently available as a biosimilar. Brand-name medications usually cost more than biosimilars.

Your cost for either drug may depend on the condition you’re using it to treat and your dosage. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Herceptin vs. Tykerb

Like Kadcyla (above), the drug Tykerb has uses similar to those of Herceptin. Here’s a comparison of how Herceptin and Tykerb are alike and different.

Ingredients

Herceptin contains the active ingredient trastuzumab. Tykerb contains the active ingredient lapatinib.

Uses

Herceptin is FDA-approved for the following uses:

• treatment of HER2-positive breast cancer (the cancer cells have abnormally high levels of a protein called HER2). For this purpose, Herceptin is used as an adjuvant treatment (therapy used to prevent cancer from returning).
• treatment of HER2-positive breast cancer that’s metastatic (has spread to other parts of the body)
• treatment of HER2-positive gastric (stomach) cancer or gastroesophageal junction adenocarcinoma that’s metastatic

Tykerb is FDA-approved for the following uses:

• treatment of advanced or metastatic HER2-positive breast cancer in those who’ve received past treatment for their breast cancer
• treatment of HER2-positive and hormone receptor-positive (HR-positive) metastatic breast cancer in postmenopausal females,* when hormonal therapy is recommended as part of treatment

* Sex and gender exist on spectrums. Use of the term “females” in this article refers to sex assigned at birth.

Drug forms and administration

Herceptin is given by infusion (an injection into your vein that’s slowly dripped in over time). It should only be given by a healthcare professional.

Tykerb is a tablet that’s taken by mouth.

Side effects and risks

Herceptin and Tykerb have some similar side effects and others that differ. Below are examples of these side effects.

Mild side effects

These lists contain examples of mild side effects that can occur with Herceptin, with Tykerb, or with both drugs (when taken individually).

• Can occur with Herceptin when used to treat breast cancer:
  • infection (skin, urinary tract, or upper respiratory)
  • fluid retention (swelling)
  • hot flashes
  • depression
  • flu (fever, chills, cough)
  • sinusitis (swelling of the sinuses)
  • bone, joint, or abdominal (belly) pain
• Can occur with Herceptin when used to treat gastric (stomach) cancer:
  • weight loss
  • upper respiratory infections (cough, runny nose, sore throat)
  • fever
  • common cold
  • change of taste
• Can occur with Tykerb:
  • hand-foot syndrome (skin reaction that often affects the hands and feet)
  • hair loss
  • decreased appetite
  • nose bleeds
  • back and leg pain
• Can occur with both Herceptin and Tykerb:
  • diarrhea (may be severe with Tykerb)
  • nausea
  • rash
  • vomiting
  • fatigue (lack of energy)
  • stomatitis (inflammation of lips, mouth, inside of cheeks, and throat)
  • insomnia (trouble sleeping)
  • headache
  • cough
  • shortness of breath

Serious side effects

These lists contain examples of serious side effects that can occur with Herceptin, with Tykerb, or with both drugs (when taken individually).

• Can occur with Herceptin:
  • anemia (low level of red blood cells)
  • thrombocytopenia (low level of platelets, a type of blood cell)
  • neutropenia (low level of white blood cells)
  • blood clot
  • kidney problems
  • neuropathy (nerve damage)
  • tumor lysis syndrome (when cancer cells release harmful chemicals into your blood)
  • reaction to the infusion*
• Can occur with Tykerb:
  • liver problems**
  • QT prolongation (changes in heart rhythm)
  • skin reaction
• Can occur with both Herceptin and Tykerb:
  • allergic reaction
  • lung problems*
  • heart problems*

* Herceptin has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). For more information, see the “FDA warnings” section at the beginning of this article.
** Tykerb has a boxed warning for this side effect.

Effectiveness

Herceptin and Tykerb have different FDA-approved uses, but they’re both used to treat breast cancer. These drugs haven’t been directly compared in clinical studies, but studies have found both Herceptin and Tykerb to be effective for treating breast cancer.

Costs

Herceptin and Tykerb are both brand-name drugs. However, Herceptin is a biologic drug and Tykerb is not. Herceptin is available in certain biosimilar forms. Tykerb is not currently available as a generic. Brand-name medications usually cost more than biosimilars and generics.

Your cost for either drug may depend on the condition you’re using it to treat and your dosage. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Herceptin vs. Herceptin Hylecta

Herceptin and Herceptin Hylecta contain the same active ingredient: trastuzumab. The main differences between these drugs relate to how they’re given and what they’re approved to treat.

See below for details on how Herceptin and Herceptin Hylecta are alike and different.

Ingredients

Herceptin contains the active ingredient trastuzumab. Herceptin Hylecta contains the active ingredients trastuzumab and hyaluronidase.

Uses

Herceptin is FDA-approved for the following uses:

• treatment of HER2-positive breast cancer (the cancer cells have abnormally high levels of a protein called HER2). For this purpose, Herceptin is used as an adjuvant treatment (therapy used to prevent cancer from returning).
• treatment of HER2-positive breast cancer that’s metastatic (has spread to other parts of the body)
• treatment of HER2-positive gastric (stomach) cancer that’s metastatic or gastroesophageal junction adenocarcinoma

Herceptin Hylecta is FDA-approved for:

• treatment of metastatic breast cancer
• adjuvant treatment of breast cancer

Drug forms and administration

Herceptin is given by infusion (an injection into your vein that’s slowly dripped in over time). Herceptin Hylecta is given by subcutaneous injection (under the skin). Both drugs should only be given by a healthcare professional.

Side effects and risks

Herceptin and Herceptin Hylecta both contain trastuzumab. Therefore, these medications can cause very similar side effects. Below are examples of these side effects. (The side effects may vary slightly because the drugs are given differently.)

Mild side effects

This list contains examples of mild side effects that can occur with both Herceptin (when treating breast cancer) and Herceptin Hylecta (when taken individually).

• Can occur with both Herceptin and Herceptin Hylecta:
  • headache
  • diarrhea
  • nausea
  • infection (skin, urinary tract, or upper respiratory)
  • insomnia (trouble sleeping)
  • cough
  • rash
  • fluid retention (swelling)
  • hot flashes
  • back, joint, or abdominal (belly) pain
  • depression
  • muscle aches, pain, or spasms

Serious side effects

This list contains examples of serious side effects that can occur with Herceptin (when treating breast cancer) or with both Herceptin and Herceptin Hylecta (when taken individually).

• Can occur with Herceptin:
  • blood clot
  • kidney problems
• Can occur with both Herceptin and Herceptin Hylecta:
  • anemia (low level of red blood cells)
  • neutropenia (low level of white blood cells)
  • thrombocytopenia (low level of platelets, a type of blood cell)
  • allergic reaction
  • neuropathy (nerve damage)
  • tumor lysis syndrome (when cancer cells release harmful chemicals into your blood)
  • heart problems*
  • reaction to the infusion or lung problems*

* Herceptin and Herceptin Hylecta both have a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). For more information, see the “FDA warnings” section at the beginning of this article.

Effectiveness

Herceptin and Herceptin Hylecta have the same FDA-approved uses, except that Herceptin is approved to treat stomach cancer and Herceptin Hylecta is not.

The use of Herceptin and Herceptin Hylecta in treating breast cancer has been directly compared in a clinical study. The study found that the medications were similar in side effects and effectiveness.

Costs

Herceptin and Herceptin Hylecta are both brand-name drugs. Herceptin is available in certain biosimilar forms. However, Herceptin Hylecta is not currently available as a biosimilar. Brand-name medications usually cost more than biosimilars.

Herceptin and Herceptin Hylecta generally cost about the same. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Common questions about Herceptin

Here are answers to some frequently asked questions about Herceptin.

How long does Herceptin stay in your body?

After you stop taking Herceptin, it will be mostly cleared out of your body within about 7 months. This can vary from person to person and may depend on your dosage and how long you took Herceptin.

Can Herceptin cause weight gain?

It’s not likely. Weight gain is not a side effect of Herceptin. However, weight gain may be a sign of a serious side effect of Herceptin, like heart problems. Call your doctor right away if you have shortness of breath, dizziness, swelling in your ankles, legs or face, or if you gain more than 5 pounds in 24 hours. This could mean the drug is causing harmful side effects, and your doctor may need to adjust your treatment.

Also, Herceptin may cause weight loss. Talk with your doctor if you have concerns about changes in your weight while taking Herceptin.

Is Herceptin a form of chemotherapy?

No. Although Herceptin is used to treat cancer, it’s not chemotherapy. It belongs to a group of medications called monoclonal antibodies, which target the HER2 gene. You may take Herceptin in addition to a chemotherapy treatment.

Does Herceptin cause hair loss?

Yes, it’s possible that Herceptin or Herceptin Hylecta can cause hair loss. How often this occurs in clinical studies varies, but in one, up to 63% of people who took Herceptin or Herceptin Hylecta reported hair loss. However, many of the studies include other cancer treatments (such as radiation and chemotherapy) that can cause hair loss. This makes it hard to know if Herceptin or Herceptin Hylecta use caused the hair loss.

Talk with your doctor if you’re concerned about how the medications you’re taking may affect your hair.

Herceptin and alcohol

There are no known interactions between Herceptin and alcohol. However, drinking alcohol may make certain side effects of Herceptin worse. These include heart problems, fluid retention (swelling), headache, and diarrhea.

If you drink alcohol, talk with your doctor about how much is safe for you to drink while taking Herceptin.

How Herceptin is given

Herceptin is given only by a healthcare professional. You’ll receive the drug through an infusion (an injection into your vein) that lasts 30 to 90 minutes, depending on your dosage schedule.

Follow all instructions from your doctor or healthcare professional related to your appointments and dosage schedule for Herceptin.

When it’s given

To help make sure you don’t miss a dose, try setting a reminder on your phone for your appointments. How often you receive Herceptin will depend on the condition it’s being used to treat.

To see the most common dosage schedules, see the “Herceptin dosage” section.

Herceptin cost

As with all medications, the cost of Herceptin can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Your insurance plan may require you to get prior authorization before approving coverage for Herceptin. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the request and let you and your doctor know if your plan will cover Herceptin.

If you’re not sure if you’ll need to get prior authorization for Herceptin, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Herceptin, or if you need help understanding your insurance coverage, help is available.

Genentech Inc., the manufacturer of Herceptin, offers a program called Herceptin Access Solutions. For more information and to find out if you’re eligible for support, call 866-422-2377 or visit the program website.

How Herceptin works

Herceptin is FDA-approved as an adjuvant treatment for certain types of breast cancer. (Adjuvant therapy is used to lower the risk of cancer coming back after treatment such as radiation or surgery.) Herceptin is also approved as treatment for breast cancer that’s metastatic (has spread from the breast to other parts of the body).

When used to treat breast cancer, Herceptin is approved for use on its own and in combination with other cancer drugs. Whether you take Herceptin alone or with other drugs will depend on your specific type of cancer and whether you’ve received treatment for your cancer in the past.

Herceptin is also FDA-approved to treat gastric (stomach) cancer and gastroesophageal junction adenocarcinoma. It’s used to treat these cancers if they’re metastatic.

When used to treat these cancers, Herceptin is used in combination with certain other cancer drugs.

Herceptin is typically used to treat cancer that’s HER2-positive (the cancer cells have abnormally high levels of a protein called HER2). Cancers that are HER2-positive usually grow quickly.

Herceptin is a monoclonal antibody that attaches to HER2 receptors (docking stations). It targets HER2-positive cells to slow their growth or kill them.

How long does it take to work?

Herceptin will begin working on your cancer cells as soon as you’ve taken the first dose. However, you may not notice Herceptin working to treat your condition. It doesn’t treat the side effects of cancer. Instead, it works to slow the growth of (and kill) HER2-positive cancer cells.

Your doctor will do various tests throughout your Herceptin treatment to monitor how well it’s working for you.

Herceptin and pregnancy

Herceptin should not be used during pregnancy. It can cause significant fetal harm or death. Your doctor will give you a pregnancy test before you start treatment.

If you’re considering pregnancy or could become pregnant, talk with your doctor. They can help you explore other treatment options. For more information, see the “FDA warnings” section.

Genentech, the manufacturer of Herceptin, has a pregnancy monitoring program in place. If you become pregnant during your Herceptin treatment or within 7 months of stopping treatment, consider calling Genentech at 888-835-2555.

Herceptin and birth control

It’s not safe to take Herceptin during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while using Herceptin. You should continue using birth control for 7 months after you stop taking Herceptin.

Herceptin and breastfeeding

It’s not known whether it’s safe to use Herceptin while breastfeeding.

It’s important to note that Herceptin may stay in your body for 7 months after you stop taking it. Talk with your doctor about the risks and benefits of breastfeeding during Herceptin treatment or in the 7 months after you stop taking the drug.

Herceptin precautions

This drug comes with several precautions.

FDA warnings

This drug has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

• Heart problems. Heart problems, including congestive heart failure (when the heart can’t pump blood effectively) may happen with Herceptin treatment. These problems are more likely to happen when Herceptin is taken with medications called anthracyclines. Examples of anthracyclines include doxorubicin (Doxil) and daunorubicin (Cerubidine). Your doctor will test your heart function before and during treatment with Herceptin. If you’ve had heart problems in the past, tell your doctor before taking Herceptin.
• Reaction to the infusion or lung problems. Herceptin is given by infusion (an injection into your vein that’s slowly dripped in over time). Some people taking Herceptin may have a reaction to the infusion. These reactions can include anaphylaxis (life threatening allergic reaction), angioedema (swelling under the skin usually caused by an allergic reaction), or low blood pressure. Some people taking Herceptin may also have lung problems like interstitial pneumonitis (inflammation in your lungs), acute respiratory distress syndrome (fluid buildup in lungs that causes less oxygen to reach the body), or trouble breathing. Both allergic reaction and lung problems usually happen during Herceptin treatment or within 24 hours of treatment. Your doctor will stop your Herceptin treatment immediately if you have a reaction to the infusion or lung problems.
• Harm to a fetus. Taking Herceptin during pregnancy can cause fetal harm or death by lowering the amount of amniotic fluid in the uterus. It’s important to use birth control to help prevent pregnancy during Herceptin treatment.

Other precautions

Before taking Herceptin, talk with your doctor about your health history. Herceptin may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

• Worsening of chemotherapy-induced neutropenia. The frequency of neutropenia (low level of neutrophils, a type of white blood cell) was higher in those who received Herceptin with chemotherapy compared to chemotherapy alone. Neutropenia is a condition that can make you more prone to serious infections. Your doctor will monitor your white blood cell counts during treatment. Let your doctor know if you’ve ever had neutropenia or currently have neutropenia before starting Herceptin.
• Pregnancy. It’s not safe to take Herceptin during pregnancy. For more information, see the “Herceptin and pregnancy” section above.
• Breastfeeding. It’s not known whether it’s safe to take Herceptin while breastfeeding. For more information, see the “Herceptin and breastfeeding” section above.

Note: For more information about the potential negative effects of Herceptin, see the “Herceptin side effects” section above.