Severe breathing difficulty, collapse, seizure or severe chest pain: call emergency services. Do not wait for an online answer.
Contact your oncology service immediately
Temperature 37.5°C or higher, 36°C or lower, shivering or suddenly feeling unwell — even with a normal temperature. Report new breathlessness, chest symptoms, severe diarrhoea, dehydration, jaundice, unusual bleeding or sudden illness promptly. Do not wait for the next planned test.
Follow the urgent contact instructions from your treating hospital. If you cannot reach the team, seek urgent medical assessment. Outside clinic hours, use your instructed out-of-hours pathway or the emergency department.
This page does not diagnose symptoms or decide whether it is safe to stay at home. You do not need to know which medicine caused a symptom before calling.
Treat HER2-positive early breast cancer as part of a plan intended to reduce the risk of it returning.
Taxane chemotherapy
Docetaxel
Disrupts the cell’s division machinery
Docetaxel stabilises tiny structures called microtubules. Cells need these to separate their chromosomes during division; disrupting the process can stop cancer cells multiplying. Healthy dividing cells are also affected.
Carboplatin creates links in DNA, making it harder for cells to copy and repair their genetic instructions. Its dose depends on kidney function as well as the intended regimen.
Platinum enters cell↓DNA links form↓Copying is disrupted
What to watch for Keep blood-test appointments. Fever, unusual bleeding, repeated vomiting or infusion symptoms need prompt advice.
Trastuzumab binds to the HER2 protein on cells and helps reduce HER2-driven growth and recruit immune activity. HER2 testing identifies the cancers for which this approach is used.
HER2 on cell surface↓Antibody binds↓Growth signalling reduced
What to watch for Attend planned echoes. Report breathlessness, ankle swelling, rapid weight gain or infusion symptoms.
Pertuzumab binds a different area of HER2 from trastuzumab. It limits receptor pairing, so the two antibodies act together at different points on the same growth pathway.
All four medicines are given by infusion on Day 1 of a 21-day cycle, for six cycles before surgery. Surgery findings guide the postoperative treatment. There is no routine take-home chemotherapy pump.
Individual plan
Surgery and selected postoperative treatment
Individual plan
After surgery, the pathology helps select the next HER2 medicine. The plan usually aims to complete about one year of HER2 treatment from the first dose. Residual invasive disease may change the treatment. Blood tests and supportive medicines must follow the selected postoperative regimen.
Relative sequence, not equal lengths or booked dates. Your team confirms actual appointments and the active medicines.
Columns show sequence, not equal durations or appointments. A test is only complete when performed and reviewed. Echo timing and cancer-imaging timing are different. Symptoms can bring any check forward.
Check
Before starting
Cycles 1–4
Around cycle 5 / week 12
Surgery / next phase
Ongoing / follow-up
Blood tests
Baseline FBC, renal and liver profile
Before each cycle; additional dose checks as prescribed
Continue the required pre-dose checks
Use the selected active regimen’s blood-test schedule
Investigate symptoms / persistent abnormalities
Echo / cardiac assessment
Baseline cardiac assessment
Earlier for symptoms / concern
Echo during neoadjuvant treatment, around cycle 5
Surgery does not restart the echo clock
Agree follow-up for the active medicine and cardiac risk
TCHP: docetaxel, carboplatin, trastuzumab and pertuzumab: the whole pathway
HER2-positive early breast cancer · before surgery
All four medicines are given by infusion on Day 1 of a 21-day cycle, for six cycles before surgery. Surgery findings guide the postoperative treatment. There is no routine take-home chemotherapy pump.
Read from left to right. Columns show stages, not equal lengths of time. This is a general plan: no dates or personal information are needed. Your team confirms which steps apply and arranges appointments.
On a small screen, swipe the map sideways. The checks below give the same timing in words.
2Heart testsCheck heart pumping function before starting HER2 treatment. Repeat echo or MUGA every 12 weeks: around cycle 5, then cycle 9 if 21-day cycles stay on time. Earlier checks are needed for symptoms or abnormal findings. Count elapsed time from the first HER2 dose; changing phase or route does not restart the clock.
Monitor pumping function and relevant rhythm risk.
Ask / act: Agree the booking owner, result reviewer and action if overdue.
3Cancer imagingBaseline breast and nodal imaging, with staging tests appropriate to the diagnosis. Review response during preoperative treatment and before surgery. After local treatment, arrange breast surveillance; routine CT, PET or tumour-marker testing is not the usual screening plan for someone without symptoms.
Assess response or follow-up needs.
Ask / act: Agree the booking owner, result reviewer and action if overdue.
4Bone healthIf the cancer is also hormone-receptor positive, endocrine treatment may form part of the wider plan. Bone-density testing is linked to aromatase inhibitors, ovarian suppression and fracture risk; it is not automatically required because a HER2 medicine is prescribed. Agree baseline DEXA where indicated and individual follow-up.
Assess fracture risk where relevant.
Ask / act: Agree the booking owner, result reviewer and action if overdue.
Which treatment phase am I in, and what happens next?
Which test is expected next, who arranges it, and who explains the result?
Who should I contact if an expected appointment has not arrived?
This map does not show whether a test has been ordered, booked or completed. Do not wait for a scheduled test if you develop new symptoms.
Day 1 → Day 21: a general pattern
This is a visual orientation, not a prediction of your personal cycle. It shows when some effects often emerge and which effects are not tied to a particular day.
All four medicines are given by infusion on Day 1 of a 21-day cycle, for six cycles before surgery. Surgery findings guide the postoperative treatment. There is no routine take-home chemotherapy pump.
Day of cycle123456789101112131415161718192021
All regimen infusions · Day 1IV
Blood counts / infectionTests and symptoms guide review
Energy and bowel symptomsTiming varies; report changes early
Numbness / tinglingCan accumulate with taxane treatment
Heart symptomsAny time; attend planned echoes
Planned treatment: All four medicines are given by infusion on Day 1 of a 21-day cycle, for six cycles before surgery. Surgery findings guide the postoperative treatment. There is no routine take-home chemotherapy pump.
Heart checks: Check heart pumping function before starting HER2 treatment. Repeat echo or MUGA every 12 weeks: around cycle 5, then cycle 9 if 21-day cycles stay on time. Earlier checks are needed for symptoms or abnormal findings. Count elapsed time from the first HER2 dose; changing phase or route does not restart the clock.
Next phase: After surgery, the pathology helps select the next HER2 medicine. The plan usually aims to complete about one year of HER2 treatment from the first dose. Residual invasive disease may change the treatment. Blood tests and supportive medicines must follow the selected postoperative regimen.
Why these bands stay broad: Treatment markers show the planned schedule. Symptom bands are broad possibilities, not measured risk curves; serious symptoms can occur at any time. Band length does not show likelihood or severity, and the chart cannot tell you whether it is safe to receive treatment. NCCP 00722 v2 · official regimen ↗
There are no guaranteed “safe days”. Fever, shivers or suddenly feeling unwell require immediate contact. Serious symptoms override the timeline or diary.
Read the whole cycle as text
Day 1–21: The current treatment cycle
All four medicines are given by infusion on Day 1 of a 21-day cycle, for six cycles before surgery. Surgery findings guide the postoperative treatment. There is no routine take-home chemotherapy pump. Your team confirms treatment dates and checks. Serious symptoms need advice on any day.
Practical treatment guide
Your practical treatment plan
All four medicines are given by infusion on Day 1 of a 21-day cycle, for six cycles before surgery. Surgery findings guide the postoperative treatment. There is no routine take-home chemotherapy pump.
STEP 1
Before the first visit
Confirm blood tests, heart assessment, active medicines, route and the consent discussion.
STEP 2
Plan venous access
A cannula, PICC or implanted port may be used. If a port is chosen, a trained team inserts it in a separate procedure with local anaesthetic and sometimes sedation; the team explains fasting, blood-thinner and wound instructions.
STEP 3
Infusion day
Trained staff check and access the line, give the prescribed premedicines and infusions, and monitor for reactions. Tell the nurse immediately about pain, burning, rash or breathlessness.
STEP 4
Home and next review
This regimen does not routinely need a take-home infusion pump. Staff disconnect the infusion; a port is de-accessed when appropriate. Keep line-care and next-visit instructions.
Port insertion and removal
The line team explains placement, dressing care and when normal activities can resume. A port is accessed with a special needle during treatment. Removal of the implanted device is a separate planned procedure when no longer needed; do not remove or adjust it yourself.
PICC care and urgent line symptoms
A PICC usually needs regular dressing and flushing appointments even between treatments. Fever, redness, swelling, pain, leakage or damage requires prompt advice. Your hospital supplies the exact care instructions.
Visit time and transport
First visits can take longer because of loading doses, premedicines and observation. Ask the unit about expected time, transport and any escort needed after sedation or line insertion.
Follow the script for the active medicine, route and treatment day. Do not carry chemotherapy anti-sickness medicines automatically into an antibody-only phase.
Tests before treatment
FBC, kidney and liver profile at baseline and before every 21-day cycle. The team reviews the necessary results before a planned dose.
Keep heart checks on the plan
An echo every 12 weeks is separate from blood tests or cancer imaging. Ask who books and reviews it.
Plan for symptoms
Keep your agreed contact numbers and instructions. New symptoms can need assessment before a routine appointment.
TCHP treats higher-risk HER2-positive breast cancer before surgery using two chemotherapy medicines and two HER2-targeted antibodies. It avoids an anthracycline. Cancer stage, lymph nodes, fitness, heart and kidney function and expected side effects guide the choice. Surgery findings determine the next treatment.
Why my team might recommend it
TCHP treats higher-risk HER2-positive breast cancer before surgery using two chemotherapy medicines and two HER2-targeted antibodies. It avoids an anthracycline. Cancer stage, lymph nodes, fitness, heart and kidney function and expected side effects guide the choice. Surgery findings determine the next treatment.
Ask which cancer features, earlier treatments and health factors led to this recommendation, which alternatives were considered and when the decision will be reviewed.
Treat HER2-positive early breast cancer as part of a plan intended to reduce the risk of it returning.
Schedule
All four medicines are given by infusion on Day 1 of a 21-day cycle, for six cycles before surgery. Surgery findings guide the postoperative treatment. There is no routine take-home chemotherapy pump.
After surgery, the pathology helps select the next HER2 medicine. The plan usually aims to complete about one year of HER2 treatment from the first dose. Residual invasive disease may change the treatment. Blood tests and supportive medicines must follow the selected postoperative regimen.
Check heart pumping function before starting HER2 treatment. Repeat echo or MUGA every 12 weeks: around cycle 5, then cycle 9 if 21-day cycles stay on time. Earlier checks are needed for symptoms or abnormal findings. Count elapsed time from the first HER2 dose; changing phase or route does not restart the clock.
Baseline breast and nodal imaging, with staging tests appropriate to the diagnosis. Review response during preoperative treatment and before surgery. After local treatment, arrange breast surveillance; routine CT, PET or tumour-marker testing is not the usual screening plan for someone without symptoms.
If the cancer is also hormone-receptor positive, endocrine treatment may form part of the wider plan. Bone-density testing is linked to aromatase inhibitors, ovarian suppression and fracture risk; it is not automatically required because a HER2 medicine is prescribed. Agree baseline DEXA where indicated and individual follow-up.
Systemic treatment comes before surgery. Lumpectomy or mastectomy is chosen with the surgical team. Radiotherapy, if indicated, follows surgery and recovery; it may overlap postoperative HER2 treatment when both teams agree. It is not automatically concurrent with the chemotherapy phase.
The treatment relationship
Systemic treatment comes before surgery. Lumpectomy or mastectomy is chosen with the surgical team. Radiotherapy, if indicated, follows surgery and recovery; it may overlap postoperative HER2 treatment when both teams agree. It is not automatically concurrent with the chemotherapy phase.
After surgery, the pathology helps select the next HER2 medicine. The plan usually aims to complete about one year of HER2 treatment from the first dose. Residual invasive disease may change the treatment. Blood tests and supportive medicines must follow the selected postoperative regimen.
Ask the team who books each test, who checks the result and who to contact if an appointment is overdue. This map does not book appointments.
What if I become unwell between visits?
Use the urgent contact plan for sudden illness, fever, chest symptoms, severe diarrhoea or poor fluid intake. Do not wait for a scheduled blood test or scan.
Why was this treatment chosen?
TCHP treats higher-risk HER2-positive breast cancer before surgery using two chemotherapy medicines and two HER2-targeted antibodies. It avoids an anthracycline. Cancer stage, lymph nodes, fitness, heart and kidney function and expected side effects guide the choice. Surgery findings determine the next treatment.
When is my next heart scan?
Check heart pumping function before starting HER2 treatment. Repeat echo or MUGA every 12 weeks: around cycle 5, then cycle 9 if 21-day cycles stay on time. Earlier checks are needed for symptoms or abnormal findings. Count elapsed time from the first HER2 dose; changing phase or route does not restart the clock.
How do other treatments fit?
Systemic treatment comes before surgery. Lumpectomy or mastectomy is chosen with the surgical team. Radiotherapy, if indicated, follows surgery and recovery; it may overlap postoperative HER2 treatment when both teams agree. It is not automatically concurrent with the chemotherapy phase.
Do I need regular scans or markers?
Baseline breast and nodal imaging, with staging tests appropriate to the diagnosis. Review response during preoperative treatment and before surgery. After local treatment, arrange breast surveillance; routine CT, PET or tumour-marker testing is not the usual screening plan for someone without symptoms.
Try explaining the plan back: Which medicines are active now, which days do you receive or take them, and who is booking and reviewing your next tests?
Regimen schedule: NCCP 00722 v2. Medicine explanations and safety information: sources below. The timeline is an educational illustration, not a measured risk curve or an individual prediction.