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Patient Handout: Ado-Trastuzumab (Kadcyla)

What is Ado-Trastuzumab?

Ado-trastuzumab, marketed under the brand name Kadcyla, is a medication used to treat HER2-positive breast cancer. It is a combination of trastuzumab (a monoclonal antibody) and DM1 (a chemotherapy drug), which is designed to deliver chemotherapy directly to cancer cells while minimizing damage to healthy cells.

Ado-trastuzumab is used to treat adults with HER2-positive breast cancer that has spread to other parts of the body (metastatic breast cancer) or after surgery if there is residual disease post neoadjuvant therapy.

How Does Ado-Trastuzumab Work?

Ado-trastuzumab works by targeting the HER2 receptor, which is found in excess on the surface of some breast cancer cells. The trastuzumab portion of the medication binds to these HER2 receptors, blocking their ability to signal cancer cells to grow.

Once bound, the chemotherapy drug DM1 is delivered directly into the cancer cell. This helps to destroy the cancer cell while minimizing damage to surrounding healthy tissue.

How is Ado-Trastuzumab Given?

  • Form: Ado-trastuzumab is given as an intravenous (IV) infusion.
  • Administration: The medication is injected into a vein by a trained healthcare professional in a hospital, clinic, or infusion center.
  • Dosage: The exact dosage and schedule will be determined by your healthcare provider. Typically, the infusion is given once every 3 weeks after the initial loading dose.
  • Loading Dose: Ado-trastuzumab is given as a larger dose during the first treatment, followed by maintenance doses every 3 weeks.

The infusion can take around 90 minutes for the first dose and may take less time for subsequent doses. Your doctor will monitor you during and after the infusion for potential side effects.

Possible Side Effects

Ado-trastuzumab can cause side effects. Some of these may be serious, so it’s important to be aware of the symptoms and inform your healthcare provider if you experience any unusual changes in your health.

Common Side Effects:

  • Fatigue: You may feel more tired than usual. Rest and conserve your energy, but inform your doctor if fatigue affects your daily activities.
  • Nausea and Vomiting: Some people may feel nauseous or vomit, especially after the infusion. Anti-nausea medications can help manage these symptoms.
  • Hair Loss: Temporary hair loss or thinning may occur. Hair usually starts to regrow after treatment ends.
  • Pain at the Injection Site: Mild pain or redness may occur at the site of the infusion, but this usually goes away after a short time.
  • Low Platelet Count (Thrombocytopenia): Ado-trastuzumab may reduce the number of platelets in your blood, which could increase your risk of bleeding. Your doctor will monitor your blood counts regularly.

Serious Side Effects:

  • Heart Problems: Ado-trastuzumab can cause heart issues, including a decrease in heart function (e.g., heart failure). Your doctor will monitor your heart closely with regular tests (such as echocardiograms or MUGA scans). If you experience symptoms such as shortness of breath, swelling of your legs or ankles, or chest pain, contact your healthcare provider immediately.
  • Liver Toxicity: Ado-trastuzumab can sometimes affect liver function. Symptoms of liver problems include yellowing of the skin or eyes (jaundice), dark urine, or abdominal pain. Report any of these symptoms to your doctor right away.
  • Infusion-Related Reactions: Some patients may experience reactions during or shortly after the infusion. Symptoms may include fever, chills, nausea, headache, or dizziness. Your healthcare provider will monitor you during the infusion to manage any reactions.
  • Low White Blood Cell Count (Neutropenia): Ado-trastuzumab may lower your white blood cell count, increasing the risk of infections. If you develop a fever, chills, or other signs of infection, contact your doctor immediately.

Precautions Before Taking Ado-Trastuzumab

Before starting treatment with ado-trastuzumab, be sure to tell your doctor about:

  • Heart Problems: Ado-trastuzumab can affect heart function, so it’s important to inform your doctor if you have a history of heart disease or heart failure.
  • Liver Disease: Ado-trastuzumab can affect your liver. Your doctor will likely perform liver function tests before starting treatment and during treatment.
  • Pregnancy and Breastfeeding: Ado-trastuzumab can harm an unborn baby. Inform your doctor if you are pregnant, planning to become pregnant, or breastfeeding. Effective contraception is recommended during treatment, and you should not breastfeed while receiving this medication.
  • Other Medications: Tell your healthcare provider about any other medications you are taking, including over-the-counter drugs, vitamins, and herbal supplements. Some drugs can interact with ado-trastuzumab and affect how it works or increase the risk of side effects.

What to Avoid While Taking Ado-Trastuzumab

  • Infections: Since ado-trastuzumab can lower your immune system’s ability to fight infections, it’s important to avoid close contact with people who have infections, especially respiratory infections. Wash your hands frequently and practice good hygiene.
  • Live Vaccines: Avoid live vaccines during treatment with ado-trastuzumab, as your immune system may not respond properly. Talk to your doctor before receiving any vaccines.
  • Grapefruit: Avoid grapefruit and grapefruit juice, as they may affect how the drug is processed by your body.

Regular Monitoring

Your healthcare provider will monitor your health regularly during treatment with ado-trastuzumab. This may include:

  • Heart function tests: Your doctor will perform tests to monitor your heart, including echocardiograms or MUGA scans, to detect any potential heart problems.
  • Blood tests: Regular blood tests will be performed to monitor your white blood cell count, liver function, and platelet count.
  • Liver function tests: To check for any liver-related side effects.

When to Contact Your Doctor

Contact your healthcare provider immediately if you experience any of the following:

  • Heart-related symptoms: Shortness of breath, swelling of the legs or ankles, or chest pain.
  • Signs of infection: Fever, chills, sore throat, or unusual tiredness.
  • Liver problems: Yellowing of the skin or eyes (jaundice), dark urine, or pain in the upper abdomen.
  • Severe nausea, vomiting, or diarrhea: That does not improve with treatment.
  • Severe injection site reactions: Redness, swelling, or pain that doesn’t go away.
  • Allergic reactions: Difficulty breathing, swelling of the face or throat, rash, or itching.

Disclaimer:

This handout is for educational purposes only and should not be considered medical advice. Always follow the instructions provided by your healthcare provider regarding treatment and care. For personalized advice, consult your healthcare provider or pharmacist.