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Treatment Name: THP (Taxotere® + Herceptin® + Perjeta®)

THP (Taxotere® + Herceptin® + Perjeta®) is a Chemotherapy Regimen for Breast Cancer - metastatic

How does THP work?
Each of the medications in THP is designed to kill cancer cells or slow growth of cancer cells.

T – Taxotere® (Docetaxel)
H – Herceptin® (Trastuzumab)
P – Perjeta® (Pertuzumab)

Goals of therapy:
THP is given to shrink tumors and slow the progression of the disease, which can decrease symptoms of breast cancer and possibly extend life. THP is not commonly given with the goal of cure.

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Schedule

  • Docetaxel intravenous (I.V.) infusion over one hour every Cycle
  • Trastuzumab I.V. infusion over 90 minutes for Cycle 1
    -then, Trastuzumab I.V. infusion over 60 minutes for Cycle 2
    -then, Trastuzumab I.V. infusion over 30 minutes for Cycles 3 and on, if tolerated
  • Pertuzumab I.V. infusion over 60 minutes for Cycle 1, plus a one hour observation time after the infusion
    -then, Pertuzumab I.V. infusion over 30 to 60 minutes for Cycles 2 and on

Estimated total infusion time for this treatment:

  • Up to seven hours for Cycle 1
  • Up to four hours for Cycle 2
  • Up to three hours for Cycles 3 and on
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

THP is usually given in an outpatient infusion center, allowing the person to go home afterwards. THP is
repeated every 21 days. This is known as one Cycle. Each cycle is repeated until the regimen no longer works or until unacceptable toxicities occur.

Click here for common starting doses.

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Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with THP are shown here:

Side effect videos Side Effect Videos
DiarrheaDiarrheaHair LossHair LossNeutropenic FeverNeutropenic FeverNausea and VomitingNausea and VomitingFatigue Fatigue ConstipationConstipationPainPain

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Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each cycle. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment then every two to three months during treatment. Imaging may include: bone scans, magnetic resonance imaging (MRI), and computerized tomography (CT) scans. Echocardiograms (heart scans) are performed before the first treatment then periodically during treatment to monitor heart function.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue THP as planned, or delay or switch therapy.

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ChemoExperts Tips

  • Remember to take dexamethasone 8 mg (two 4 mg tablets) by mouth twice daily the day before, the day of infusion, and the day after receiving docetaxel to help prevent excess fluid from staying in your body. If you forget, be sure to alert the doctor, nurse, or pharmacist at the infusion center. An intravenous (I.V.) dose of dexamethasone may be given if you forget to take home doses
  • Infusion reactions can happen the first few cycles and may extend overall time spent at the infusion center. This treatment should be started early in the day if possible
  • 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 THP (Taxotere® + Herceptin® + Perjeta®), 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 THP (Taxotere® + Herceptin® + Perjeta®). Depending upon your income, they may be able to help cover the cost of:

  • Docetaxel
  • Herceptin®
  • Pertuzumab

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 THP (Taxotere® + Herceptin® + Perjeta®) 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.

Emotional Wellness

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 THP (Taxotere® + Herceptin® + Perjeta®)

Individual Drug Label Information

Docetaxel (Taxotere®)

  • Docetaxel iIs an intravenous (I.V.) infusion
  • There is an increased  chance of death in patients treated with this drug who have poor liver function, are treated with higher doses, in patients with non-small cell lung cancer and a history of using other “platinum-based chemotherapy” drugs
  • Docetaxel should not be given when a certain blood cell count, neutrophils, get below 1500 cells.  The physician may hold therapy or reduce the dose and continue treatment if this occurs
  • Dosage adjustment may be required for poor liver function
  • Severe fluid retention may occur, especially when combined with prednisone
  • Docetaxel may interact with strong CYP3A4 inhibitors (e.g. ketoconazole) and proteosome inhibitors (e.g. Ritonavir) may increase concentrations of docetaxel and lead to increased toxicity or side effects. More frequent laboratory monitoring and docetaxel dosage adjustment may be needed
  • Severe hypersensitivity may occur, although rare
General Docetael (Taxotere) Side Effects
  • Hair loss
  • Low red blood cell count and fatigue
  • Nausea/vomiting
  • Diarrhea
  • Low white blood cell count and associated infections. Blood cell counts, including neutrophils (ANC) should be checked regularly
  • Nail changes on fingers and toes
  • Loss of sensation
  • Swelling in the extremities
  • Mouth sores 
  • Changes in taste
  • Loss of appetite
  • Shortness of breath
  • Muscle pain
  • Tearing of eyes or vision problems
  • Heart problems
  • Click on the docetaxel (Taxotere) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Herceptin® (Trastuzumab)

  • Herceptin is an intravenous infusion 
  • Your heart function should be checked before starting trastuzumab and every 3 months while on therapy. If your heart's ability to pump decreases, treatment may need to be interrupted for a period of time to let your heart function to improve. You may also be started on several medications to help improve your heart function 
  • Although rare, severe lung toxicity. The risk of this side effect is increased in patients with various lung diseases who receive trastuzumab 
  • May cause severe birth defects when given to pregnant women. Use proper birth control methods while on trastuzumab and notify your doctor if you become pregnant during therapy 
General Trastuzumab (Herceptin) Side Effects 
  • Can cause infusion reactions that most likely occur during the first infusion. If these occur, you may need to receive acetaminophen, diphenhydramine, and a corticosteroid before all future doses 
  • May cause skin rash 
  • May cause persistent cough, runny nose, or trouble breathing 
  • Click on the trastuzumab (Herceptin) package insert below for reported side effects and possible drug interactions
See DailyMed package insert.

Pertuzumab (Perjeta®)

  • Pertuzumab is an intravenous infusion 
  • Your heart function should be checked before starting pertuzumab and every 3 months while on therapy. If your heart's ability to pump decreases, treatment may need to be interrupted for a period of time to let your heart function to improve. You may also be started on several medications to help improve your heart function 
  • May cause severe birth defects when given to pregnant women. Use proper birth control methods while on pertuzumab and notify your doctor if you become pregnant during therapy 
General Pertuzumab (Perjeta) Side Effects  
  • Can cause infusion reactions that most likely occur during the first infusion. If these occur, you may need to receive acetaminophen, diphenhydramine, and a corticosteroid before all future doses. Typically, patients are observed for 30-60 minutes after each infusion is finished to monitor for any reactions
  • Frequently causes significant diarrhea. This can be managed with over-the-counter medications such as loperamide, or a prescription medication such as Lomotil (diphenoxylate + atropine)
  • May cause skin rash 
  • Click on the pertuzumab (Perjeta) package insert for reported side effects and possible drug interactions

Side Effect Videos
DiarrheaDiarrheaFatigue Fatigue

See DailyMed package insert.

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References

Baselga J, Cortés J, Kim SB, et al. Pertuzumab plus Trastuzumab plus Docetaxel for Metastatic Breast Cancer. N Engl J Med. 2012;366:109-119.

Created: January 23, 2016 Updated: January 23, 2016

What is Breast Cancer - metastatic?

What is Metastatic Breast Cancer?
A disease of the milk-producing glands known as lobules, milk ducts, or other cells found in the breast. Metastatic breast cancer is one that has moved from the breast to other areas of the body, which may include the brain, liver, or bone. Breast cancer is one of the most common types of cancers in women, but may rarely affect men as well. Known causes of breast cancer include genetic causes, such as the BRCA mutation, or obesity. The effectiveness of the treatment may depend upon the stage at diagnosis.

Types of metastatic breast cancer:
1. Hormone-receptor positive or negative (60 - 65% of patients)

  • Estrogen Receptor positive (ER)+ or negative (ER)-
  • Progestin Receptor positive (PR)+ or negative (PR)-

2. Hormone Epidermal growth factor Receptor-2 (HER-2) positive or negative (20 - 25% of patients)

  • HER-2 +
  • HER-2 -

3. Triple Negative (15 - 18% of patients)

  • ER- and PR- and (HER-2)-
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

Common Starting Doses

  • Docetaxel 75 mg/m2 intravenous (I.V.) infusion over 1 hour on Day 1
  • Trastuzumab 8 mg/kg I.V. infusion over 90 minutes on Day 1 of Cycle 1
    -then, Trastuzumab 6 mg/kg I.V. infusion over 60 minutes for Cycle 2
    -then, Trastuzumab 6 mg/kg I.V. infusion over 30 minutes for Cycles 3 and on if tolerated
  • Pertuzumab 840 mg I.V. infusion over 60 minutes on Day 1 of Cycle 1, plus a one-hour observation time after the infusion
    -then, Pertuzumab 420 mg I.V. infusion over 30 to 60 minutes on Day 1 of Cycles 2 and on

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium