Perjeta
Perjeta (pertuzumab) is a targeted anticancer treatment for HER2-positive breast cancer that’s either in the early or metastatic stage. Perjeta (pertuzumab) is given as an infusion into your veins, and it’s typically used along with other anticancer medications. People who receive Perjeta (pertuzumab) might develop heart problems or experience an infusion-related reaction.
What is Perjeta (pertuzumab)?
What is Perjeta (pertuzumab) used for?
- HER2-positive breast cancers, together with Herceptin (trastuzumab) and chemotherapy
How Perjeta (pertuzumab) works
Perjeta (pertuzumab) is a monoclonal antibody that acts as a human epidermal growth factor receptor 2 (HER2) inhibitor. It blocks a specific protein in the body that’s important for cell growth called HER2. HER2 is found on both normal and cancer cells. Cancer cells usually have more HER2 proteins than normal cells. This can cause cancer cells to grow more quickly than normal cells. When HER2 is blocked by Perjeta (pertuzumab), cancer cells can’t grow and spread as well.
Drug facts
Side effects of Perjeta (pertuzumab)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
The following side effects happened in people who took Perjeta (pertuzumab) together with Herceptin (trastuzumab) with or without chemotherapy. Some side effects (e.g., mouth sores, hair loss) might be related more to the chemotherapy treatment than Perjeta (pertuzumab).
- Diarrhea (up to 72%)
- Nausea (up to 71%)
- Hair loss (up to 67%)
- Fatigue (up to 58%)
- Nerve problems in hands or feet (tingling or numbing sensation; up to 42%)
- Weakness or lack of energy (up to 41%)
- Vomiting (up to 40%)
- Constipation (up to 38%)
- Anemia (up to 38%)
- Mucosal inflammation (mouth sores, mouth or gut inflammation; up to 37%)
- Rash (up to 34%)
- Muscle pain (up to 33%)
- Headache (up to 30%)
Less Common Side Effects
- Lower appetite
- Changes in how things taste
- Indigestion
- Cough
- Nose bleed
- Dry skin
- Fever
- Dizziness
- Joint pain
- Swelling of the arms and legs
- Changes in the appearance of your nails
- Trouble sleeping
Perjeta (pertuzumab) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Infusion-related or allergic reactions: fever, chills, dizziness, nausea, headache, sweating, rash, swelling of the face or throat, trouble breathing
- Heart problems: shortness of breath; dry cough; swelling of legs, arms, or face; irregular heartbeats; dizziness; sudden weight gain
The following Perjeta (pertuzumab) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Black, tarry stools
burning, numbness, tingling, or painful sensations
chills
fast heartbeat
hoarseness
joint pain, stiffness, or swelling
lower back or side pain
painful or difficult urination
pale skin
redness of the skin
swelling of the eyelids, face, lips, hands, or feet
tightness in the chest
troubled breathing or swallowing
ulcers, sores, or white spots in the mouth
unsteadiness or awkwardness
unusual bleeding or bruising
unusual tiredness or weakness
weakness in the arms, hands, legs, or feet
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Perjeta (pertuzumab)
Pros
- Preferred first-choice treatment option for HER2-positive advanced breast cancer
- Can take as little as 30 minutes to infuse your dose (after the first infusion)
- More precise in the way it targets cancer cells compared to traditional chemotherapy
Cons
- Can cause heart failure or other heart problems and requires regular monitoring of heart function
- Not a single-medication treatment plan for breast cancer
- Requires regular visits to the clinic or infusion center to receive your dose
Pharmacist tips for Perjeta (pertuzumab)
- Stay on track with your Perjeta (pertuzumab) infusions. Putting your infusion appointments into your calendar can help you remember. If you miss a dose, let your provider know so they can decide what the next steps are. If it’s been at least 6 weeks since your last infusion, your provider might need to adjust your dose.
- Each infusion appointment can take a few hours because it includes the time it takes to check in, get the infusion of Perjeta (pertuzumab) and possibly other anticancer medications, and monitor for side effects. Make sure you have what you need to be comfortable during that time. Wear sleeves that are easy to roll up, bring a water bottle to help you stay hydrated, and bring a snack.
- You might experience a reaction during or shortly after your Perjeta (pertuzumab) infusion. Let your provider know right away if you experience any infusion reactions like fever, chills, headache, or vomiting.
- Diarrhea is a common side effect of Perjeta (pertuzumab). Some ways to help manage this side effect include avoiding foods that are greasy, fatty, or spicy and eating small, frequent meals. Also, be sure to stay hydrated by drinking plenty of clear, noncarbonated drinks.
- If you’re a female who can get pregnant, you should use birth control while receiving Perjeta (pertuzumab) together with Herceptin (trastuzumab) and for 7 months after the last dose. This medication can cause harm to an unborn baby. Let your provider know right away if you become pregnant during treatment.
Common questions about Perjeta (pertuzumab)
There are several situations when Perjeta (pertuzumab) can be used to treat HER2-positive breast cancer. The medication can help with early-stage breast cancer that hasn’t spread beyond the breast area. In early-stage breast cancer, Perjeta (pertuzumab) can be used to help shrink the size of the tumor before it’s surgically removed (neoadjuvant therapy). Another treatment plan during this stage of breast cancer is getting Perjeta (pertuzumab) after the tumor surgery to help get rid of any part of the tumor that might be left over (adjuvant therapy). In addition, Perjeta (pertuzumab) can help treat metastatic breast cancer that has spread to other areas of the body. Discuss with your provider whether Perjeta (pertuzumab) is an option for your breast cancer.
Your Perjeta (pertuzumab) infusion should take about 30 to 60 minutes to complete. But the length of time can also depend on how well you tolerate the infusion. If you’re experiencing an infusion reaction (e.g., fever, chills, tiredness, headache, vomiting), your provider might need to slow or temporarily stop the infusion to manage your symptoms. This will make the infusion take longer to finish. After your Perjeta (pertuzumab) infusion ends, you’ll likely have to stay for another 1 hour (for the first infusion) or 30 minutes (for the rest of your infusions) so your provider can continue to watch for any reactions. During your appointment, you’ll also receive other medication infusions that’s part of your treatment plan, which could take another few hours. Be prepared to spend several hours at your provider’s office or clinic to complete all of your medication infusions.
No. Chemotherapy is a class of medication that targets and kills cancer cells in your body. Perjeta (pertuzumab) doesn’t kill cancer cells. Instead, it works by slowing cancer cell growth. However, you’ll need to receive certain chemotherapy medications with Perjeta (pertuzumab) as part of your breast cancer treatment. Possible chemotherapy agents used with Perjeta (pertuzumab) include docetaxel (Taxotere) or paclitaxel. Your provider will decide which medications are best for you and your cancer.
It isn’t known if Perjeta (pertuzumab) can pass into breast milk and what effects the medication has on nursing infants if it does. Discuss with your provider about the risks and benefits of breastfeeding while getting Perjeta (pertuzumab) infusions. To be safe, they might recommend that you avoid breastfeeding during treatment and for up to 7 months after your last dose. Your provider can help answer any questions you have about breastfeeding or recommend other ways to feed your baby while receiving Perjeta (pertuzumab) or after treatment.
Perjeta (pertuzumab) only contains pertuzumab and is injected into the vein. It’s typically given with a separate infusion of Herceptin (trastuzumab). On the other hand, Phesgo (pertuzumab / trastuzumab / hyaluronidase) is a combination medication containing both pertuzumab and trastuzumab that’s injected subcutaneously. Phesgo also contains a protein called hyaluronidase, which helps your body absorb the medication better when injected under the skin. While Perjeta (pertuzumab) is injected into the vein over 30 to 60 minutes, Phesgo is injected under the skin over 5 to 8 minutes.
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Risks and warnings for Perjeta (pertuzumab)
Perjeta (pertuzumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart failure
- *Risk factors: Previous use of other herat-damaging anticancer medications | Previous radiation to the chest *
HER2 inhibitors like Perjeta (pertuzumab) can affect how well your heart pumps blood through your body and can even cause new or worsening heart failure. You might be at higher risk if you’ve used other heart-damaging anticancer medications before. Make sure your provider has your full medical history, so they can closely monitor your heart through imaging using an echocardiogram or a MUGA scan. You’ll need to get this scan before starting treatment and about every 3 months while receiving Perjeta (pertuzumab). Let your care team know if you experience any signs and symptoms of heart failure, including shortness of breath; dry cough; swelling of legs, arms, or face; irregular heartbeats, dizziness; or rapid weight gain.
Harm to unborn baby
HER2 inhibitors like Perjeta (pertuzumab) and Herceptin (trastuzumab) might cause harm to an unborn baby. If you're a female who’s able to become pregnant, your provider might check to see if you’re pregnant before you start treatment. You should also use birth control while you’re receiving Perjeta (pertuzumab) together with Herceptin (trastuzumab) and for at least 7 months after your last dose. Let your provider know right away if you or your partner become pregnant during this time.
Infusion-related and allergic reactions
People receiving Perjeta (pertuzumab) might experience infusion-related or allergic reactions. These reactions can happen during an infusion or at a later time on the same day as the infusion. Severe reactions like anaphylaxis are rare. Your provider will observe you for 1 hour after your first infusion to watch out for any symptoms of a reaction. But for the rest of your infusions, they’ll only need to observe you for 30 minutes after your dose. Alert your provider or get medical help right away if you experience any symptom of an infusion reaction. Symptoms include fever, chills, tiredness, headache, and vomiting. If a reaction occurs, your healthcare provider can slow down or stop the infusion and manage your reaction appropriately.
Perjeta (pertuzumab) dosage
Typical dosage for Perjeta (pertuzumab)
Perjeta (pertuzumab) is given by a healthcare provider as an injection into a vein (intravenously or IV).
The typical dose is 840 mg IV for the first infusion, and then 420 mg given once every 3 weeks.
Interactions between Perjeta (pertuzumab) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Daunorubicin
- Daunorubicin Citrate Liposome
- Daunorubicin Liposome
- Doxorubicin
- Epirubicin
- Idarubicin
- Pirarubicin
- Pixantrone
- Tofacitinib
- Valrubicin
What are alternatives to Perjeta (pertuzumab)?
