Anti-HER2 therapy: how to use Herceptin in clinical practice

The recombinant, humanized monoclonal antibody Herceptin is administered as an initial 4 mg/kg i.v. infusion over 90 min, followed by weekly 2 mg/kg i.v. infusions over 30 min. In pivotal clinical trials Herceptin, both as a single agent and in combination with chemotherapy, was found to produce a significant survival benefit in HER2-positive metastatic breast cancer patients. Importantly, Herceptin was well tolerated and was not associated with a poor side-effect profile, producing mainly mild to moderate side-effects. These were generally associated with the initial infusion. The incidence of adverse events was low with Herceptin therapy and severe vomiting and alopecia, typical of many chemotherapy treatment regimens, were not experienced by patients in the trials. Cardiac dysfunction was the most significant Herceptin-related adverse event but could, in most cases, be managed using standard therapy. The favourable adverse event profile seen with Herceptin is reflected in the quality of life (QoL) data. The health-related QoL of patients receiving Herceptin therapy alone or in combination with chemotherapy was found to be maintained. Previous studies have noted a deterioration of health-related QoL in patients treated with chemotherapy only. Thus, as well as providing significant survival benefit, Herceptin therapy improves patient well being.