This maintenance treatment continues HER2 blockade to help control metastatic or unresectable recurrent HER2-positive breast cancer after chemotherapy.
Medicines, schedule, tests, side effects, daily life, with sources and practical actions.
Open complete patient reference → Explore your 21-day timeline →Draft — independent clinical, pharmacy and patient/PPI review pending · prepared 2026-10-21
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.
Report diarrhoea early, especially with poor fluid intake. Keep cardiac checks and report infusion symptoms immediately.
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.
Attend planned echoes. Report breathlessness, ankle swelling, rapid weight gain or infusion symptoms.
Cycle numbers are examples for uninterrupted three-weekly treatment. Schedule checks by elapsed time and clinical need. Moving to maintenance does not restart the cardiac-monitoring clock. The clinical team books and reviews results; this map does not track completed tests.
| Check | Before this phase | Before every 21-day cycle | Week 12 · around C5 | Weeks 24 / 36 · around C9 / C13 | Later / treatment change |
|---|---|---|---|---|---|
| Heart pumping test · echo / MUGA | Review baseline / latest cardiac assessment and the next due date | Review symptoms; echo is not automatically needed before every infusion | Repeat at 12 weeks; earlier if symptoms or impairment | Continue every 12 weeks; preserve the existing due date | NCCP 12-weekly default while treatment continues; a different interval needs an explicit specialist plan. |
| Blood tests | Baseline FBC, renal and liver profile | FBC, renal and liver tests before every cycle | Continue pre-cycle blood tests | Continue pre-cycle blood tests | Follow abnormalities and the next treatment plan |
| Cancer imaging / markers | Record disease sites and the comparison scan | Review new symptoms at every visit | Metastatic: response scans when due under the individual plan | Individual scan interval; markers only if informative | Metastatic scans commonly every 2–4 months; not an NCCP fixed-cycle rule |
| ECG / bone health | ECG when indicated by cardiac assessment; DEXA only if endocrine / fracture risk indicates | No automatic every-cycle ECG or DEXA | Risk-based clinical plan | Risk-based clinical plan | Keep any separately prescribed endocrine and bone-health follow-up |
Maintenance · HER2-positive metastatic / unresectable recurrent breast cancer
Pertuzumab and trastuzumab continue after the chemotherapy part of the metastatic treatment plan. Maintenance remains active treatment, with response and heart checks.
On a small screen, swipe the map sideways. The checks below give the same timing in words.
| Care / check | Earlier combination | Maintenance transition | Every 3 weeks | Regular response review | Beyond year 1 |
|---|---|---|---|---|---|
| Cancer medicinesNCCP 00726 | Chemotherapy with HER2 treatment | Review benefit, tolerance and last dose date | Pertuzumab + trastuzumab infusions | Continue while benefit and tolerance support the plan | Ongoing treatment; no fixed one-year stopping rule |
| Local / endocrine careMETASTATIC · EARLY | Prior surgery or radiation varies | Discuss symptom-directed local treatment | Radiotherapy only if separately indicated | Endocrine therapy may be considered if HR-positive | MDT agrees any changes |
| Blood testsNCCP 00726 | Carry previous results forward | Blood count, kidney and liver tests | Before each cycle | Additional tests when indicated | Continue according to the active regimen |
| Heart ultrasoundNCCP 00726 · ESC | Count from first HER2 exposure | Check latest echo and due interval | Symptoms reviewed every visit | NCCP: echo every 12 weeks | 12-weekly default; interval changes require cardiac risk review |
| Cancer scansMETASTATIC | Baseline extent documented | Use prior scans as comparison | Report new symptoms between scans | Usually every 2–4 months; modality / interval individualised | Keep a documented response-assessment plan |
| Tumour markersMARKERS | Consider if informative | Confirm whether used for this person | No universal marker schedule | Adjunct to symptoms and scans, never alone | Continue only when clinically useful |
Checks heart function while treatment continues.
Ask / act: Ask when the next echo is due; a move to maintenance does not restart the clock.
Sources: NCCP 00726 · ESC
A baseline scan records where the cancer is. Response is usually reviewed every 2–4 months, adjusted for the treatment, disease pace, symptoms and previous results. CT chest/abdomen/pelvis is common when appropriate; the team chooses the imaging needed for the known sites.
Ask / act: Ask what scan is planned, when results will be discussed and who to contact for new symptoms.
Sources: METASTATIC
CA 15-3 or CEA may be helpful in selected metastatic cases, especially if previously raised. They support the assessment with symptoms and imaging; a marker alone does not decide whether treatment is working or should change.
Ask / act: Ask what a change means alongside the scan and clinical review.
Sources: MARKERS
A long gap can change the required antibody loading doses.
Ask / act: Contact the team to confirm the new prescription; do not assume the old visit plan still applies.
Sources: NCCP 00726
This particular NCCP code is for metastatic/unresectable recurrent maintenance.
Ask / act: Ask the team to confirm the setting and aim on the written plan.
Sources: NCCP 00726
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.
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.
Pertuzumab and trastuzumab are given by infusion every 21 days after the chemotherapy phase of the metastatic treatment plan. Duration depends on benefit, tolerance and the agreed plan; this is not a fixed one-year adjuvant course.
There are no guaranteed “safe days”. Fever, shivers or suddenly feeling unwell require immediate contact. Serious symptoms override the timeline or diary.
Pertuzumab and trastuzumab are given by infusion every 21 days after the chemotherapy phase of the metastatic treatment plan. Duration depends on benefit, tolerance and the agreed plan; this is not a fixed one-year adjuvant course.
Before maintenance, review blood tests, the latest heart assessment, prior treatment response, last antibody doses and the next echo due date.
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.
Check treatment tolerance and symptoms, then receive the prescribed pertuzumab and trastuzumab infusions with observation. Premedicines depend on previous reactions and the individual plan; they are not automatic chemotherapy premedication.
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.
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.
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.
The visit includes review, infusions and observation. Maintenance does not automatically require new loading doses; an interval of 6 weeks or longer needs review of both antibody loading schedules. Ask your team for the expected visit time.
Open practical treatment guide · Printable practical guide
Sources: NCCP 00726 v3a · official regimen · eviQ · PICC patient information · eviQ · implanted port patient information. Draft — independent clinical, pharmacy and patient/PPI review pending.
Numbered symptom boxes connect to the anatomical illustration. The medicine responsible may be uncertain; report the symptom.
Keep scheduled echoes. New breathlessness, ankle swelling or reduced exercise tolerance: contact oncology promptly.
During treatment, tell staff immediately about flushing, rash, chest tightness or breathing difficulty.
123Report frequent / watery stools early, especially with dizziness or poor fluid intake.
Confirm the last treatment date with the team; long gaps can change the loading-dose plan.
Echoes continue on maintenance. Report new breathlessness, ankle swelling or rapid weight gain.
Report diarrhoea early and follow the agreed hydration/support plan.
Keep response-review appointments. Ask for support with fatigue, activity, sexual wellbeing and practical concerns.
Acute Oncology Service
Ask for medical oncology
Other hospitals: use the numbers your team provides.
Report new breathlessness, chest symptoms, severe diarrhoea, inability to drink, jaundice, a painful swollen leg or a severe rash promptly. You do not need to identify which medicine caused the symptom.
Two-page guide with the body map, treatment schedule and QR.
Open visual guide →One page for each cycle, with a separate symptom table for each medicine.
Open treatment passport →Regimen identity, cycle stamps and the contact plan.
Open treatment card →For your treatment discussion: one-page consent aid · individualised discussion draft. These support the approved local consent process.
https://sactcheck.com/patient/00726/ · QR contains no patient information.
NCCP defines this regimen; other sources explain medicines and symptoms. Clinical and patient review is pending.