Paclitaxel and Trastuzumab (The James)

Paclitaxel and Trastuzumab (The James)

 

What is Paclitaxel (pak-li-TAX-el) and how does it work?

Paclitaxel is a chemotherapy medicine known as an “anti-microtubule inhibitor”. Another name for this medicine is Taxol. It is a natural medicine that comes from the bark of Pacific Yew trees. This medicine fights cancer by stopping fast growing cancer cells from dividing and making new cancer cells.

 

What is Trastuzumab (tras-TOO-zoo-mab) and how does it work?

Trastuzumab is a type of targeted cancer therapy called a “monoclonal antibody”. Another name for this medicine is Herceptin. Trastuzumab seeks out cancer cells and attaches to the HER2 receptors, to prevent the cells from dividing and making new cancer cells.

 

Why am I getting 2 treatment medicines for my cancer?

Both medicines work to stop fast growing cancer cells from dividing and making new cells, but they attack the cancer cells differently. Giving the 2 medicines together makes your treatment more effective.

 

What should I tell my doctor before my treatment?

  • If you have ever had chemotherapy or anti-cancer treatment and the name of the medicines you were given.
  • If you have ever had heart, liver or lung problems.
  • If you are allergic to medicines that contain Cremophor EL.
  •  If you are allergic to mice.
  • If you are pregnant or think you may be pregnant. Your doctor will talk to you about birth control when you take these medicines.
  • If you are breastfeeding.
  • If you have been told that you need to start a new medicine.
  • The medicines/pills you are taking, including:
    • Medicines ordered by any of your doctors
    • Herbs
    • Vitamins
    • Over-the-counter medicines

 

How does my doctor decide my treatment dose?

To determine your treatment dose, your doctor will review the following: your stage of cancer, your height, your weight, your medicines, how well your heart and liver work and any other health problems you have.

This treatment is given 1 day each week. Some patients may be treated with paclitaxel and trastuzumab for 12 weeks, and then continue treatment with only trastuzumab for up to a year, including before and after surgery. Other patients may be given paclitaxel and trastuzumab as long as they do not have too many side effects and cancer is not getting worse. You will see your doctor or nurse practitioner 1 day each month during your treatment.

 

Should I eat or drink before my treatment?

It is best to eat a small meal  and drink plenty of fluids before your treatment begins. If you have been told to limit fluids, check with your doctor about how much you can drink.

 

How will my treatment be given?

You will be given several medicines 30 to 60 minutes before your treatment to prevent you from having an allergic reaction. These medicines may affect your abilities. For your safety, you should have someone drive you home. 

Paclitaxel is given directly into your blood stream through a tube (IV) placed in your arm or chest. Paclitaxel comes in a bag with tubing attached. Your nurse will connect the tubing to a pump. This treatment takes between 1 and 3 hours depending on your treatment dose. 
 
Trastuzumab is given directly into your blood stream through a tube (IV) placed in your arm or chest. Trastuzumab comes in a bag with tubing attached. Your nurse then connects this to a pump. Your first treatment will take 90 minutes. If you do not have any problems with your first treatment, then your future treatments will only take 30 minutes.

Your entire visit, including your doctor’s appointment and your treatment, will take 3 to 6 hours.

 

What are the side effects of this treatment?

Every person responds differently to treatment. Some of the more common side effects of this treatment are:

  • Numbness, tingling and pain in your hands and feet
  • Fatigue or weakness
  • Hair loss, including the hair on your head and body (this normally begins 10 to 14 days after receiving Paclitaxel)
  • Mouth pain or open sores in your mouth
  • Low white blood cell count (may increase your risk for infection)
  • Low platelet count (may cause you to bleed more easily or longer than normal and have more bruising)
  • Muscle or joint aches and pain
  • Allergic reaction to the treatment including: difficulty breathing, hives, or swelling of your face
  • Changes in your nails
  • Flu-like symptoms: chills, fever, headache, body aches, and sweating (more common with your first few doses of Trastuzumab)
  • Mild nausea
  • Diarrhea
  • Cough
  • Rash 

 

When should I call my doctor?

You should call your doctor right away if you have any of the following signs or symptoms:

  • Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher 

A fever can be life threatening if not treated. Your doctor may ask you to go to the hospital.

  • Chills, sore throat, cough or a wound that does not get better
  • Numbness, tingling or pain that prevents you from doing simple tasks such as walking, buttoning your shirt or holding a cup
  • Open sores in your mouth
  • Nausea that prevents you from eating or drinking
  • Any vomiting, even if you only vomit once
  • Skin redness or blisters where the Paclitaxel was given
  • Bleeding or bruising, including bloody or black stools or blood in your urine
  • Diarrhea (4 or more loose stools in 24 hours)
  • Changes in your heartbeat
  • Shortness of breath or difficulty breathing
  • Yellowing of your skin or eyes
  • Pain in your chest
  • Swelling in your feet or ankles
  • Fast weight gain

 

Is there anything else I should know about this treatment?

  • Some patients may have an allergic reaction while this treatment is being given. To prevent this, you will be given a medicine before your treatment. If an allergic reaction happens, your nurse will give you medicine to help manage the reaction and take extra precautions during your next treatment. 
  • Trastuzumab may cause problems with the pumping of your heart. Your doctor will check your heart before you start this medicine and every several months during treatment.
  • Paclitaxel may make it harder for your body to fight infections. Wash your hands often and stay away from people who are sick.
  • Paclitaxel requires special precautions to prevent the medicine from coming into contact (through blood, urine, bowel movements, vomit and vaginal or seminal fluids) with others. Your  nurse will give you guidelines to follow for 48 hours after your treatment.
  • Paclitaxel can change how your body reacts to vaccines. Talk to your doctor before getting any vaccines.
  • It is important to keep hydrated during treatment. Unless told otherwise by your doctor, drink 8 to 10 cups of non-caffeinated fluid each day.
  • Do not get pregnant or breastfeed while receiving this treatment or for 7 months after your last treatment. Tell your doctor right away if you become pregnant.
  • Paclitaxel may cause women to stop having menstrual cycles. Depending on your age, your menstrual cycles may or may not return.
  • This treatment may affect your ability to have children. It may be hard to get pregnant even after your treatment has ended. Talk to your doctor before you start treatment if you are planning to have children in the future.

For more information about cancer, cancer treatments, side effects or how to care for yourself during treatment, ask your doctor, nurse or pharmacist.

You may also find it helpful to watch The James Patient Education videos at http://cancer.osu.edu/patientedvideos to help you learn tips for managing treatment side effects.

 


© November 3, 2021.  The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.