Pertuzumab + trastuzumab maintenance
21-day cycleDraft — independent clinical, pharmacy and patient/PPI review pendingSevere breathing difficulty, collapse, seizure or severe chest pain: call emergency services. Do not wait for an online answer.
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, inability to drink, jaundice, a painful swollen leg or a severe rash promptly. You do not need to identify which medicine caused the symptom.
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.
Open your CUH contact / treatment cardThis maintenance treatment continues HER2 blockade to help control metastatic or unresectable recurrent HER2-positive breast cancer after chemotherapy.
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.
What to watch for
Report diarrhoea early, especially with poor fluid intake. Keep cardiac checks and report infusion symptoms immediately.
Sources: nccp
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.
What to watch for
Attend planned echoes. Report breathlessness, ankle swelling, rapid weight gain or infusion symptoms.
Sources: nccp
The drawings are simplified explanations of drug action, not anatomical pictures or a prediction of response.
Explore your existing anatomy and side-effect mapPertuzumab 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.
A general pathway, not an appointment calendar. Your team confirms the order, overlap and duration; no date entry is needed.
Sources: nccp
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. Keep planned tests and call for symptoms at any time.
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.
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.
The chemotherapy part of your earlier combination has finished. Pertuzumab and trastuzumab continue to target HER2 while the team reviews cancer control and treatment tolerance. Maintenance remains active treatment.
The chemotherapy part of your earlier combination has finished. Pertuzumab and trastuzumab continue to target HER2 while the team reviews cancer control and treatment tolerance. Maintenance remains active treatment.
Sources: nccp
This card contains the two HER2 antibodies and no routine cytotoxic chemotherapy. Heart checks, infusion-reaction precautions and attention to diarrhoea remain important. This metastatic maintenance pathway has no fixed one-year stopping point; it is different from treatment after surgery for early breast cancer.
Sources: nccp
Ask which cancer features, earlier treatments and health factors led to this recommendation, what alternatives were considered, and when the plan will be reviewed.
Sources: nccp
Confirm the setting and the plan.
This maintenance treatment continues HER2 blockade to help control metastatic or unresectable recurrent HER2-positive breast cancer after chemotherapy.
Sources: nccp
Pertuzumab and trastuzumab continue after the chemotherapy part of the metastatic treatment plan. Maintenance remains active treatment, with response and heart checks.
Sources: nccp
Checks and preparation matter.
NCCP: baseline and every 12 weeks during HER2 treatment. Checks heart function while treatment continues. Ask when the next echo is due; a move to maintenance does not restart the clock.
Usually every 2–4 months; earlier if clinically needed. 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 what scan is planned, when results will be discussed and who to contact for new symptoms.
Sources: metastatic
Ask for support that fits your priorities.
Confirm the last treatment date with the team; long gaps can change the loading-dose plan.
Sources: nccp
Echoes continue on maintenance. Report new breathlessness, ankle swelling or rapid weight gain.
Sources: nccp
Report diarrhoea early and follow the agreed hydration/support plan.
Sources: nccp
Keep response-review appointments. Ask for support with fatigue, activity, sexual wellbeing and practical concerns.
Sources: nccp
The next phase has its own checks.
This particular NCCP code is for metastatic/unresectable recurrent maintenance. Ask the team to confirm the setting and aim on the written plan.
Sources: nccp
New or lasting symptoms need assessment between appointments and after treatment stops. Ask for a written summary of continuing medicines, follow-up tests and the contact plan.
Sources: hse
Pertuzumab and trastuzumab continue after the chemotherapy part of the metastatic treatment plan. Maintenance remains active treatment, with response and heart checks.
No. Both charts explain the expected sequence and general intervals without any dates or personal information. Your hospital arranges actual appointments.
The treatment journey lists baseline and ongoing checks, why they matter and what to ask. It does not mark tests as booked or completed.
Your team may delay, reduce, change or stop a medicine. Ask which component changes and what happens to the next review; do not restart independently.
Discuss fertility preservation and reproductive plans before treatment. The team should explain contraception and breastfeeding restrictions for every medicine, including how long precautions continue afterwards.
Trial results describe groups with defined eligibility. Ask how well those patients and their treatment match your situation; the figures are not an individual prediction.
The chemotherapy part of your earlier combination has finished. Pertuzumab and trastuzumab continue to target HER2 while the team reviews cancer control and treatment tolerance. Maintenance remains active treatment. This card contains the two HER2 antibodies and no routine cytotoxic chemotherapy. Heart checks, infusion-reaction precautions and attention to diarrhoea remain important. This metastatic maintenance pathway has no fixed one-year stopping point; it is different from treatment after surgery for early breast cancer.
Regimen schedule: NCCP 00726 v3a. Medicine explanations and safety information: sources below. The timeline is an educational illustration, not a measured risk curve or an individual prediction.