Treatment Name: Ado-trastuzumab emtansine (Kadcyla®)
Ado-trastuzumab emtansine (Kadcyla®) is a Chemotherapy Regimen for Breast Cancer - metastatic
How does ado-trastuzumab emtansine work?
It targets a protein on the surface of breast cancer cells known as human epidermal growth factor receptor 2 (HER-2). Once it is bound to the protein, it then enters the cells and releases a chemical called DM-1 which stops the cell from growing or dividing.
Goals of therapy:
Ado-trastuzumab emtansine is given to shrink breast cancer tumors and slow the disease, which can decrease symptoms and extend life. It is not commonly given with the goal of cure.
- Ado-trastuzumab emtansine intravenous infusion (I.V.) over 90 minutes on Day 1 of Cycle 1, then over 30 minutes on Day 1 of all following cycles
Estimated total infusion time for this treatment:
- Up to 3 hours for Cycle 1, Day 1; as short as 1.5 hours for the next cycles if well tolerated. If there are any infusion-related reactions, the infusion may need to be stopped
- The observation time may last 30 to 90 minutes after the infusion to monitor for any infusion-related reactions
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and I.V. fluids, such as hydration, may add more time
Ado-trastuzumab emtansine is usually given in an outpatient infusion center, allowing the person to go home afterwards. This treatment is repeated every 21 days, which is known as one Cycle. Each cycle is repeated until the drug no longer works or until unacceptable side effects occur.
Click here for common starting doses.
In clinical studies, the most commonly reported side effects with ado-trastuzumab emtansine are shown here:
A note about side effect percentages
- Nausea (39%)
- Fatigue (35%)
- Increased bleeding risk [low platelets; thrombocytopenia] (28%)
- Diarrhea (23%)
- Vomiting (19%)
- Anemia [low red blood cells] (10%)
- Low blood potassium (9%)
- Mouth sores (7%)
- Low white blood cells [neutropenia] (6%)
- Skin redness and peeling on palms of hands and soles of feet (1%)
On average, 6% of patients discontinue treatment with ado-trastuzumab due to unacceptable side effects.
Importantly, not all people who experience a side effect from Ado-trastuzumab emtansine (Kadcyla®) will experience it in the same way. It may be mild in some or severe in others, depending upon the individual. Everybody is different. Additionally, side effects may vary over time. For some, side effects may be a reason to delay or switch treatment, reduce the dose, or avoid future treatment with a certain medication altogether.
Side effects may be treatable when they occur or preventable by taking certain medications before they happen. When medications are taken to prevent a problem, this is known as prophylaxis, or "prophy" for short.
After starting treatment with (Kadcyla®), be sure to come back and watch all of the side effect videos shown below. Each of these videos contain valuable information about side effect management that will hopefully help you to both feel better and stay out of the hospital.
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), and Comprehensive Metabolic Panel (CMP). Heart function is checked for ejection fraction before and during treatment.
How often is imaging needed?
Imaging may be checked before treatment and every two to four cycles during treatment. Imaging may include: bone scans and computerized tomography (CT) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue ado-trastuzumab emtansine as planned, or delay or switch therapy.
- The risk of experiencing low platelets from ado-trastuzumab emtansine may be higher in patients with Asian ancestry
- Your heart function will be checked before starting treatment and repeated every 3 months while receiving treatment with ado-trastuzumab emtansine. This is done by either an echocardiogram or a MUGA scan. Signs of decreased heart function include shortness of breath, dizziness, and swelling in ankles and feet
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for breast cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Ado-trastuzumab emtansine (Kadcyla®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Ado-trastuzumab emtansine (Kadcyla®). Depending upon your income, they may be able to help cover the cost of:
- Ado-trastuzumab emtansine
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Ado-trastuzumab emtansine (Kadcyla®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Ado-trastuzumab emtansine (Kadcyla®)