Acute Oncology Service
SACTCheck · treatment passport
Pertuzumab + trastuzumab maintenance
A record of what you experience
One cycle per page. Each medicine has its own symptom table. Mark the worst symptoms since your last review, when they occurred and what they stopped you doing. Overlapping symptoms can be recorded under more than one medicine; you do not have to identify the cause.
These are patient-language severity prompts, not a validated questionnaire or a formal CTCAE grading tool. Your team assigns the clinical grade. Serious symptoms override the columns: call without waiting to decide a severity level.
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.
The four pages are reusable recording sheets, not a prescribed four-cycle course. Ask for additional sheets as needed.
Emergency: 112 / 999. Severe breathing difficulty, collapse, seizure or severe chest pain needs emergency help.
Contact oncology immediately for temperature ≥37.5°C or ≤36°C, shivering or suddenly feeling unwell, even with a normal temperature. Follow your own hospital’s instructions. If you cannot reach the team, seek urgent medical assessment.
Ask for medical oncology
Other hospitals: use the numbers your team provides.
Your own hospital / contact instructions:
https://sactcheck.com/patient/00726/
Full patient information, sources and visual timeline. No identifiers are encoded.
Draft — independent clinical, pharmacy and patient/PPI review pending
NCCP 00726 v3a · one cycle, one page
Pertuzumab + trastuzumab maintenance
Cycle number: __________ Start date: __________ Next review: __________
Pertuzumab · HER2-targeted antibody
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
Trastuzumab · HER2-targeted antibody
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
Dates / doses missed or changed / symptoms affecting daily life / questions:
Red flags override the table. Fever, shivers, suddenly unwell, chest symptoms or inability to drink: seek prompt advice. Severe breathing difficulty, collapse or severe chest pain: 112 / 999.
NCCP 00726 v3a · one cycle, one page
Pertuzumab + trastuzumab maintenance
Cycle number: __________ Start date: __________ Next review: __________
Pertuzumab · HER2-targeted antibody
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
Trastuzumab · HER2-targeted antibody
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
Dates / doses missed or changed / symptoms affecting daily life / questions:
Red flags override the table. Fever, shivers, suddenly unwell, chest symptoms or inability to drink: seek prompt advice. Severe breathing difficulty, collapse or severe chest pain: 112 / 999.
NCCP 00726 v3a · one cycle, one page
Pertuzumab + trastuzumab maintenance
Cycle number: __________ Start date: __________ Next review: __________
Pertuzumab · HER2-targeted antibody
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
Trastuzumab · HER2-targeted antibody
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
Dates / doses missed or changed / symptoms affecting daily life / questions:
Red flags override the table. Fever, shivers, suddenly unwell, chest symptoms or inability to drink: seek prompt advice. Severe breathing difficulty, collapse or severe chest pain: 112 / 999.
NCCP 00726 v3a · one cycle, one page
Pertuzumab + trastuzumab maintenance
Cycle number: __________ Start date: __________ Next review: __________
Pertuzumab · HER2-targeted antibody
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
Trastuzumab · HER2-targeted antibody
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
Dates / doses missed or changed / symptoms affecting daily life / questions:
Red flags override the table. Fever, shivers, suddenly unwell, chest symptoms or inability to drink: seek prompt advice. Severe breathing difficulty, collapse or severe chest pain: 112 / 999.