Severe reaction to 1st dose of Herceptin

janet/FL · 12-09-2007, 03:35 PM

I always had them give the drugs, Herceptin included, very, very slowly. Hope this and the right premeds work for you. I haven't seen anyone posting about changing what Herceptin was mixed with but I sure think I read this a year or so ago. Be sure to ask your second opinion oncologist about it.

Roz · 12-09-2007, 06:11 PM

Hi,
I'm not sure where you are in Austalia, I am in Sydney and had my first Herceptin injection (back in Jan 2005) at St Vincent's. They gave it to me over 1 and a half hours, and i had a severe reaction. However, I went back the following week (was only having a weekly dose then) and had the next one over 2 hours. No problem. Went on to have no problems whatsoever with Herceptin for the period of time it worked for me. So don't give up hope, you WILL get this drug to work for you!!

Joanne S · 12-09-2007, 10:32 PM

Janet/FL,

I found this information on the Genentch site:

HOW SUPPLIED
Herceptin (Trastuzumab) is supplied as a lyophilized, sterile powder nominally containing 440 mg Trastuzumab per vial under vacuum.
Each carton contains one vial of 440 mg Herceptin® (Trastuzumab) and one vial containing 20 mL of Bacteriostatic Water for Injection, USP, 1.1% benzyl alcohol. NDC 50242‑134‑68.

Preparation for Administration Reconstitution
Each vial of Herceptin should be reconstituted with 20 mL of BWFI, USP, 1.1% benzyl alcohol preserved, as supplied, to yield a multi‑dose solution containing 21 mg/mL Trastuzumab. The reconstituted preparation results in a colorless to pale yellow transparent solution. Parenteral drug products should be inspected visually for particulates and discoloration prior to administration. Reconstituted Herceptin must be discarded after 28 days.
Use of diluents other than BWFI should be avoided unless contraindicated. For patients with known hypersensitivity to benzyl alcohol, Herceptin must be reconstituted with Sterile Water for Injection; discard any unused portion.
Herceptin should not be mixed or diluted with other drugs. Herceptin infusions should not be administered through an IV line containing dextrose solutions.

http://www.gene.com/gene/products/information/oncology/herceptin/insert.jsp#administration

Joanne S · 12-09-2007, 11:34 PM

Also found on the Genentech site:

Infusion Reactions During the first infusion with Herceptin, a symptom complex most commonly consisting of chills and/or fever was observed in approximately 40% of patients in clinical trials. The symptoms were usually mild to moderate in severity and were treated with acetaminophen, diphenhydramine, and meperidine (with or without reduction in the rate of Herceptin infusion); permanent discontinuation of Herceptin for infusional toxicity was required in <1% of patients. Other signs and/or symptoms may include nausea, vomiting, pain (in some cases at tumor sites), rigors, headache, dizziness, dyspnea, hypotension, elevated blood pressure, rash, and asthenia. Infusional toxicity occurred in 21% and 35% of patients, and was severe in 1.4% and 9% of patients, on second or subsequent Herceptin infusions administered as monotherapy or in combination with chemotherapy, respectively.

Per Wikipedia: Rigor is a shaking occurring during a high fever. It occurs because cytokines and prostaglandins are released as part of an immune response and increase the set point for body temperature in the hypothalamus.

The increased set point causes the body temperature to rise (pyrexia), but also makes the patient feel cold until the new set point is reached. Rigor occurs because the patient is effectively shivering in a physiological attempt to increase body temperature to the new set point.

hermiracles · 12-12-2007, 05:12 AM

Thanks ladies for the extra information - it is all very helpful. I did discuss this with the 2nd Oncologist and she sees no reason for me not to try the Herceptin again - with slower infusion and increased and appropriate pre-med.

I'll let yous know how I go!
Thanks
Blessings all
Hermiracles

Bill · 12-14-2007, 07:26 PM

Hello Hermiracles! I can imagine how trying that must have been for you and your husband. Thank God it wasn't worse. My wife never had a reaction to Herceptin, but when she began her first treatment, she was on a clinical trial of Lapatinib (Tykerb), Taxol, and Herceptin. At each infusion of the Taxol, they gave her Decadron, Aloxi, and the Benadryl. We discovered early on that if they gave her the Benadryl at the standard rate (10-15 minutes, I think) she got really antsy, so they slowed it to 30 minutes and then she dozed mostly. Sometimes they gave her Ativan as well. At that time she had a "temperamental" port and if she moved very much, it would quit feeding. She had liver mets, but also 2 mets on her spine, and they gave her Zometa once a month as a bone srengthener. I'm not in the medical field, but I was wondering if maybe that could help you as well. I don't know the pros and cons of Zometa, but it made Nikki feel like she had the flu for a few days. Also, at our treatment center, they would give premeds in the same order for everyone, Benadryl, Aloxi, Decadron. I noticed some people were getting sick within 30 minutes of infusion,(some I think were new and understandably scared), so I suggested to the nurses that sometimes Aloxi should be given first in those cases and it seemed to help. Don't be reluctant to ask alot of questions and sometimes the chemo. nurses, God bless them all, do tend to get into the same routine on premeds. Sometimes changing the order may help. Stay strong, Bill

12-26-2009, 12:32 PM

I was lucky to find this forum. I had the most horrible reaction to my first dose of Herceptin. I ended up in the Emergency room of my local hospital. The constant shaking and fever, high heart beat terrified me and my husband. They gave me Benydryl and fluids to rehydrate me and I feel much better today.
I had read through all your posts and am now better armed to tackle this question with my doctor. While I'm sure the doctor knows how to deal with severe reactions it will do no harm to have her understand that I too am now informed and have a few suggestions of my own

Thank you everyone on this board for posting and giving us Noobi's a little direction and support.

SoCalGal · 12-31-2009, 12:29 AM

I think it is very possible and likely that you will do just fine with benedryl pre-med and maybe the steroid, too. FOR SURE they should infuse very slowly. Even now, after years, I have Herceptin over an hour. Most people have theirs in half-hour.

Second story - several years ago, after (4) taxotere treatments with no problems, right in the middle of treatment #5 I suddenly felt like I was going to die - pass out, couldn't breathe, and could only quickly yell for help. They shut my drip and I recovered quickly. They gave me some benedryl and then the doc came in. "I want you to finish your drip today". It was one of the hardest things I ever had to do, let them turn that drip back on. But they ran it very slowly and I was fine.

Third thing - you are like me - the ever-ready bunny. We are crazy warrior-women. You are not going anywhere. Forget about dying. You are going to raise those kids. I promise.

Blessings back to you!
Flori