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Perjeta
pertuzumab
Black Box Warnings .
Cardiomyopathy
subclinical and clinical cardiac failure, manifesting as decr. LVEF and CHF can occur; evaluate left ventricular function prior to and during tx; D/C tx if clinically significant decr. left ventricular function
Embryo-Fetal Toxicity
exposure during pregnancy or within 7mo prior to conception can result in embryo-fetal death and birth defects, including oligohydramnios and delayed renal development; advise patients of risks and need for effective contraception
Adult Dosing .
Dosage forms: INJ
Special Note
- [equivalency or interchangeability info]
- Info: not interchangeable with SC pertuzumab/trastuzumab/hyaluronidase
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing including toxicity-related dose adjustments
HER2-positive breast CA, metastatic
- [420 mg IV x1 on day 1 of 21-day cycle, starting cycle 2]
- Start: 840 mg IV x1 for cycle 1; Info: part of multi-drug chemo regimen
HER2-positive breast CA, early
- [neoadjuvant tx]
- Dose: 840 mg IV x1 on day 1 of 21-day cycle for cycle 1, then starting cycle 2, administer 420 mg IV x1 on day 1 of 21-day cycle; Info: for patients with locally advanced, inflammatory, or early stage disease with either >2cm in diameter or node positivity; give x3-6 cycles in neoadjuvant setting as part of multi-drug chemo regimen, then continue in adjuvant setting with trastuzumab or trastuzumab/hyaluronidase for total of 18 cycles
- [adjuvant tx]
- Dose: 840 mg IV x1 on day 1 of 21-day cycle for cycle 1, then starting cycle 2, administer 420 mg IV x1 on day 1 of 21-day cycle; Info: for patients with high recurrence risk; give x3-6 cycles as part of multi-drug chemo regimen, then continue with trastuzumab or trastuzumab/hyaluronidase for total of 18 cycles
renal dosing
- [see below]
- CrCl >30: no adjustment; CrCl <30: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- avoid: breastfeeding during tx and x7mo after D/C
- caution: patients of childbearing potential
- caution: LVEF decr.
- caution: LVEF decr, trastuzumab-associated
- caution: CHF history
- caution: chest radiation history
- caution: anthracycline use history
- caution: HTN, uncontrolled
- caution: MI, recent
- caution: arrhythmia, serious
Drug Interactions .
Overview
pertuzumab
HER2/neu antagonist
- cardiotoxic effects
- immunomodulatory effects
Contraindicated
- adenovirus vaccine, live
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- rotavirus vaccine, live
- smallpox vaccine, live
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Avoid/Use Alternative
- epirubicin
- idarubicin
- rabies vaccine
Monitor/Modify Tx
- adalimumab
- ado-trastuzumab emtansine
- aficamten
- aldesleukin
- alogliptin
- anagrelide
- anthrax vaccine
- asciminib
- avelumab
- avian influenza vaccine
- axitinib
- bevacizumab
- bezlotoxumab
- binimetinib
- bortezomib
- bosutinib
- capecitabine
- carfilzomib
- certolizumab pegol
- chikungunya vaccine
- cilostazol
- clozapine
- cobimetinib
- COVID-19 vaccine
- cyclophosphamide
- dabrafenib
- daunorubicin
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- doxorubicin
- dronedarone
- ebola vaccine, live
- encorafenib
- entrectinib
- etanercept
- fam-trastuzumab deruxtecan
- fluorouracil
- golimumab
- Haemophilus b vaccine
- hepatitis A vaccine
- hepatitis B vaccine
- human papillomavirus vaccine
- hydroxychloroquine
- ibrutinib
- ifosfamide
- imatinib
- infliximab
- influenza vaccine
- interferon beta 1a
- interferon beta 1b
- interferon gamma 1b
- itraconazole
- Japanese encephalitis vaccine
- lapatinib
- lenvatinib
- linagliptin
- margetuximab
- mavacamten
- meningococcal vaccine
- mirdametinib
- mitoxantrone
- mobocertinib
- osimertinib
- pazopanib
- peginterferon beta 1a
- pioglitazone
- pneumococcal vaccine
- poliovirus vaccine
- ponatinib
- propafenone
- respiratory syncytial virus vaccine
- ripretinib
- ropeginterferon alfa-2b
- rosiglitazone
- saxagliptin
- selumetinib
- sitagliptin
- smallpox/mpox vaccine, live
- sorafenib
- sunitinib
- tick-borne encephalitis vaccine
- tivozanib
- trabectedin
- trametinib
- trastuzumab
- typhoid vaccine
- vandetanib
- zanidatamab
- zenocutuzumab
- zongertinib
Adverse Reactions .
Serious Reactions
- cardiac failure
- cardiomyopathy
- left ventricular dysfunction
- CHF
- infusion reaction, severe
- hypersensitivity reaction
- anaphylaxis
- angioedema
- anemia
- leukopenia
- neutropenia
- febrile neutropenia
Common Reactions
- diarrhea
- alopecia
- nausea
- fatigue
- peripheral neuropathy
- vomiting
- neutropenia
- constipation
- anemia
- stomatitis
- rash
- myalgia
- arthralgia
- appetite decr.
- dysgeusia
- asthenia
- headache
- fever
- insomnia
- peripheral edema
- hot flashes
- epistaxis
- cough
- lacrimation incr.
- dyspepsia
- xeroderma
- dyspnea
- nail disorder
- febrile neutropenia
- pruritus
- dizziness
- nasopharyngitis
- paresthesia
- abdominal pain
- radiation skin injury
- extremity pain
- leukopenia
- URI
- infusion reaction
- hypersensitivity reaction
Safety/Monitoring .
Monitoring Parameters
pregnancy test at baseline; LVEF at baseline, then regularly during tx; signs/symptoms of infusion reaction during and x60min after 1st infusion, then during and x30min after subsequent infusions
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; risk of oligohydramnios, delayed fetal renal development, and embryo-fetal death based on animal data at 2.5-20x recommended human dose
Pregnancy Reporting
report pregnancy during tx and within 7mo of last dose to Genentech at 1-888-835-2555
Individuals of Reproductive Potential
obtain pregnancy test before tx start; avoid pregnancy by using effective contraception during tx and x7mo after D/C in patients of childbearing potential
Lactation
Clinical Summary
avoid breastfeeding during tx and x7mo after D/C; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: for pertuzumab: unknown; CYP450: unknown
Excretion: for pertuzumab: unknown; Half-life: 18 days
Subclass: HER2 Antagonists ; Immunotherapy, HER2 Inhibitors
Mechanism of Action
for pertuzumab: blocks HER2 heterodimerization, resulting in cell growth arrest and apoptosis; mediates antibody-dependent cell-mediated cytotoxicity
Formulary .
No Formulary Selected
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