1- What's herspiten?

Herceptin (trastuzumab) is a immunological therapy.  It’s an antibody prepared in the laboratory and has the ability to go to the cancer cells and binds to the surface antigens on the cancer cells to stop or delay their division

2- What are antibodies?

Antibodies are proteins normally produced in the body in response against microbes and foreign bodies

3- What is the mechanism of action of herceptin?

Herceptin selectively binds with high affinity to the extracellular protein called "human epidermal growth factor receptor 2" (HER2).  HER2 is overexpressed in some types of breast cancer cells.

Herceptin binds to the protein HER2 and delay or stop the division and proliferation of cancer cells, and stimulating the immune system to destroy the cancer cells without harming the healthy cells

Herceptin is used only in the treatment of breast cancer that overexpress HER2 protein. And should not be used if the tumor showed negative results to the HER2 test

4- Why is the breast caner with overespressed HER2 protein considered a different variant?

Breast cancer with overexpressed HER2 protein represents 30% of all diagnosed breast cancer

This type that test positive for HER2 test tend to grow more rapidly  and has a higher risk of relapse from other types.  In addition it has a tendency to spread to the brain, therefore the doctor do brain scan during therapy

5- How to know wither the tumor has overexpressed HER2 protein or not?

They protein is identified and its quantity measured in the laboratory by two methods;

• The first method is by using histological dyes: in this method cells are classified according to how much they absorb the dye from zero to 3. Where the zero means the test is negative, while 3 means its positive and the patient "God willing" would benefit from the drug. Patients with results of1 or 2 need to get the second test
• The second method is by measuring the number of copies of DNA in the nucleus using the so called test "fish"

6- How is herceptin used in treating breast cancer?

·         Herceptin is certified by the U.S. Food and Drug Administration for the treatment of metastasized breast cancer (phase 4 of breast cancer where the cancer cells has spread to other parts of body) with overepressed HER2 protein.

·         In the year of 2005, 4 major clinical researches showed that herceptin is effective also in the treatment of early case of breast cancer with overerxpressed HER2,  it also revealed that women who received chemotherapy and herceptin lived longer and the probability of relapse was less than patients who received chemotherapy alone.

7- how is herceptin given?

• Its given via intravenous  route in the chemotherapy treatment room (daily care clinic)
• The first dose is usually given over 90 minutes under the supervision of a nurse or the treating physician to notice any side effectives during the drug administration.  The proceeding doses are given in the same way under supervision over 30 minutes.
• Herpisten can be given weekly or once every 3 weeks for a year (17 dose) as determined by the treating physician
• In the first dose the patients must stay in the hospital for 6 hours since starting the medication to insure there is no adverse reaction

8- is there any side effects for herceptin?

Yes

The drug can decrease the ability of the heart to pump blood to the rest of the body in 3-7% of the patients taking the medication. Therefore cardiac evaluation is done prior to starting treatment and 3 months later

The symptoms of declining heart muscle: difficulty breathing, swelling of the legs and gasping after minimal activity.

In addition, Herceptin lead to hypersensitivity. the symptoms are: falling blood pressure, shortness of breath And skin rash. Most of those who suffer from hypersensitivity reactions are at the beginning of treatment or within 24 hours. This is why the preventive measures mentioned above were set

The patient must also remember accurately whether she has any other health problems that may be in conflict with the medicine

The patients who notice any problems during or after the medication must inform the treating physician of go to the nearest emergency department

Other side effects, that decrease in intensity after the first does are:

• Diarrhea, redness, irritation in the site of administration, pain in muscles.
• Headaches and difficulty breathing
• Pain in the back and stomach, abdominal pain, sleep disorders.
• Nausea and vomiting that could be very sever in some cases

To decrease the symptoms of nausea and vomiting;

• The treating physician might prescribe a medication to lessen the nausea and vomiting
• Take verity of small snakes
• Try to avoid eating before the treatment
• Physical activity will help to relieve these symptoms
• If these symptoms are still present, inform your treating physician

Patient receiving chemotherapy with Herceptin might have different the side effects from those receiving Herceptin alone, examples are: anemia, and inflammation of upper respiratory tract

Remember; your doctor gave you this drug to the extent of his knowledge that its benefits are more than the potential side effects, and these effects are few compared to the size of advantages the patient will get

9- Can herceptin be taken during pregnancy?

Herceptin can harm the infant if taken during pregnancy

Therefore the doctor must be infrom the case of

• Pregnancy
• Considering pregnancy
• Delay of menstruation or doubt of pregnancy  

10- Who are the patients who are not preferred to take herceptin?

As mentioned in previous questions that herceptin cause declining in heart muscle in 3-7% of patients taking this medication

Therefore it's preferred not to give this drug in

• Previous cardiac attack
• Congestive heart failure
• Arrhythmias
• Uncontrolled hypertension
• Breathing problems

11- Are there any special instructions or precautions I need to do when taking the drug Herceptin?

No, there are no special instructions to be taking during therapy

You can continue your daily activities as before the therapy, just inform your doctor if you have any allergies or breathing difficulties