(per TU zoo mab)

Trade Name: Perjeta™

Pertuzumab is the generic name for the trade name drug Perjeta™. In some cases, health care professionals may use the trade name Perjeta™ when referring to the generic drug name Pertuzumab.

Drug Type:

Pertuzumab is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "­­­­­­­­­antineoplastic agent and a monoclonal antibody". (For more detail, see “How Pertuzumab Works” below).

What Pertuzumab Is Used For:

• Indicated in combination with trastuzumab and chemotherapy for the treatment of patients with HER2-positive breast cancer. HER2 expression must be present for initiation of pertuzumab using FDA-approved test.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Pertuzumab Is Given:

• As an infusion into a vein (intravenous, IV) over 60 minutes.

Side Effects:

Important things to remember about the side effects of Pertuzumab:

• Most people will not experience all of the Pertuzumab side effects listed.
• Pertuzumab side effects are often predictable in terms of their onset, duration, and severity.
• Pertuzumab side effects will improve after therapy is complete.
• Pertuzumab side effects may be quite manageable. There are many options to minimize or prevent the side effects of Pertuzumab.

The following side effects are common (occurring in greater than 30%) for patients taking Pertuzumab. Reactions reported in combination therapy with trastuzumab and docetaxel:

• Diarrhea
• Hair loss
• Low white blood cell count
• Nausea
• Fatigue
• Rash
• Peripheral neuropathy (numbness & tingling in hands and feet)

These are less common (occurring in 10-29%) side effects for patients receiving Pertuzumab Reactions reported in combination therapy with trastuzumab and docetaxe:

• Decreased appetite
• Mouth irritation or mouth sores
• Weakness
• Anemia
• Swelling
• Muscle aches
• Nail changes
• Joint aches
• Shortness of breath
• Headache
• Fever
• Abnormal taste
• Upper respiratory tract infection
• Vomiting
• Itching
• Watery eyes
• Difficulty sleeping
• Dizziness
• Abdominal pain
• Dry skin
• Allergic reactions/hypersensitivity reactions

Not all side effects are listed above. Side effects that are very rare -- occurring in less than about 10 percent of patients -- are not all listed here. But you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night or go to the emergency room, if you should experience any of the following symptoms:

• Fever of 100.4º F (38º C) or higher, chills (possible signs of infection)
• Signs of a reaction (wheezing; chest tightness; fever; itching; bad cough; blue or grey skin color; seizures; swelling of the face, lips tongue or throat)
• Trouble breathing
• Chest pain or pressure or a fast heartbeat

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

• Signs of infection: Fever, chills, very bad sore throat, ear or sinus pain, cough with or without sputum, pain with passing urine, wounds that will not heal
• Nausea (interferes with ability to eat and unrelieved with prescribed medication)
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Diarrhea (4-6 episodes in a 24-hour period)
• Dizziness or lightheadedness
• Bad headache
• Big weight gain
• Unusual bleeding or bruising
• Extreme fatigue (unable to carry on self-care activities)
• Muscle weakness
• Mouth sores (painful redness, swelling or ulcers)

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting Pertuzumab treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
• Do not receive any kind of immunization or vaccination without your doctor’s approval while taking Pertuzumab.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Pertuzumab may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.)
• For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking Pertuzumab. Barrier methods of contraception, such as condoms, are recommended. Verify pregnancy status prior to treatment initiation. Effective contraception should be used during therapy and for 6 months after treatment.
• Do not breast feed while taking Pertuzumab.

Self-Care Tips:

• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1 teaspoon of baking soda mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• Follow regimen of anti-diarrhea medication as prescribed by your health care professional.
• Eat foods that may help reduce diarrhea (see managing side effects - diarrhea).
• Acetaminophen or ibuprofen may help relieve discomfort from fever, headache and/or generalized aches and pains. However, be sure to talk with your doctor before taking it.
• Avoid sun exposure. Wear SPF 15 (or higher) sun block and protective clothing.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
• Get plenty of rest.
• Maintain good nutrition.
• Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
• If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

• Lab work to check blood counts and liver/kidney functions will be checked regularly by your health care professional while you are taking Pertuzumab, to monitor side effects and check your response to therapy.

• HER2 expression must be present for initiation of pertuzumab (either as 3+ IHC [Dako Herceptest™] or FISH amplification ratio >2 [Dako HER2 FISH pharmDx™ test]).

• Negative pregnancy test prior to initiation.

• Cardiac studies to assess Left Ventricular Ejection Fracture (LVEF), may be ordered.

How Pertuzumab Works:

Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects.

Targeted therapy is about identifying other features of cancer cells. Scientists look for specific differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

There are different types of targeted therapies, defined in three broad categories. Some targeted therapies focus on the internal components and function of the cancer cell. The targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. There are several types of targeted therapy that focus on the inner parts of the cells. Other targeted therapies target receptors that are on the outside of the cell. Therapies that target receptors are also known as monoclonal antibodies. Antiangiogenesis inhibitors target the blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.

Pertuzumab has the component of an antibody type of targeted therapy. Antibodies are an integral part of the body’s immune system. Normally the body creates antibodies in response to an antigen (such as a protein or a germ) that has entered the body. The antibodies attach to the antigen in order to mark it for destruction by the immune system. To make anti-cancer antibodies in the laboratory, scientists analyze specific antigens on the surface of cancer cells (the targets). Then using animal and human proteins, they create a specific antibody that will attach to the target antigen on the cancer cells. When given to a patient, these antibodies will attach to matching antigens like a key fits a lock. Since antibodies target only specific cells, they may cause less toxicity to healthy cells. Monoclonal antibody therapy is usually only given for cancers in which antigens and the respective antibodies have been identified already.

Pertuzumab is a monoclonal antibody which targets the surface of the cells human epidermal growth factor receptor 2 protein (HER2) on the cancer cell, interfering with HER2 causing cancer cell death. Pertuzumab binds to a different area of the HER2 protein than trastuzumab so that when pertuzumab is combined with trastuzumab, a more complete blockage of HER2 signaling occurs.

Research continues to identify which cancers may be best treated with targeted therapies and to identify additional targets for more types of cancer.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

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