Precautions for Trastuzumab

During the treatment of patients with trastuzumab (Trastuzumab), patients need to pay attention to the occurrence of cardiomyopathy, infusion reactions, pulmonary toxicity, exacerbation of neutropenia, embryo-fetal toxicity and other events.

1. Cardiomyopathy: Trastuzumab can cause left ventricular dysfunction, arrhythmia, hypertension, disabling heart failure, cardiomyopathy and cardiac death, and can also cause asymptomatic reduction in left ventricular ejection fraction (LVEF); compared with patients who did not receive trastuzumab treatment, the incidence of symptomatic myocardial dysfunction increased 4-6 times in patients who received trastuzumab monotherapy or combination therapy. If trastuzumab is discontinued due to severe left ventricular dysfunction, repeat LVEF measurements every 4 weeks and every 6 months for at least 2 years after completion of adjuvant trastuzumab therapy.

2. Infusion reactions: include a combination of symptoms characterized by fever and chills, sometimes including nausea, vomiting, pain (in some cases at the tumor site), headache, dizziness, dyspnea, hypotension, rash, and fatigue. In post-marketing reports, serious and fatal infusion reactions have been reported, including bronchospasm, anaphylaxis, angioedema, hypoxia, and severe hypotension. For all patients who experience severe infusion reactions, permanent discontinuation of trastuzumab should be strongly considered.

3. Pulmonary toxicity: including dyspnea, interstitial pneumonia, pulmonary infiltrates, pleural effusion, non-cardiogenic pulmonary edema, pulmonary insufficiency and hypoxia, acute respiratory distress syndrome and pulmonary fibrosis. Patients with symptomatic intrinsic lung disease or extensive tumor involvement of the lungs causing dyspnea at rest appear to have more severe toxicity.

4. Exacerbation of neutropenia caused by chemotherapy: The per capita incidence of NCI-CTC grade 3-4 neutropenia and febrile neutropenia was higher in patients who received trastuzumab combined with myelosuppressive chemotherapy than in patients who received chemotherapy alone. The incidence of septic death was similar in patients who received trastuzumab and in patients who did not receive trastuzumab.

5. Embryo-fetal toxicity: In post-marketing reports, the use of trastuzumab during pregnancy resulted in a series of cases of oligohydramnios and oligohydramnios, manifested as pulmonary hypoplasia, skeletal abnormalities, and neonatal death. Exposure to trastuzumab during pregnancy or within 7 months before conception may cause fetal damage. Advise females of reproductive potential to use effective contraception during treatment and for 7 months after the last dose of trastuzumab.

Trastuzumab is sold under the brand name Herceptin in China and has entered the scope of Class B medical insurance, but it may be limited to patients who meet the indications for this drug, such as patients with HER2-positive metastatic breast cancer and its adjuvant and neoadjuvant treatment or HER2-positive metastatic gastric cancer. The price is around 6,000 yuan. The original trastuzumab drug has also been launched overseas. The drug ingredients of domestic and foreign original drugs are basically the same. For specific prices and drug details, you can consult the medical consultant. There is currently no generic drug of trastuzumab on the market.