Herceptin Not Given Weekly from Week 2-18

MCMC1 · April 2019

The administration guideline on the Herceptin website specifies that it should be injected weekly from weeks 2-18 for TCH treatment. However, the doctor at my public hospital administers Herceptin every 3 weeks starting from week 1, ignoring the weekly regimen, is this going to increase my recurrence rate?

hapa · April 2019

Every three weeks is the norm. The only people i know of that get weekly Herceptin are the ones that are getting weekly Taxol and once they're finished with the weekly Taxol infusions, they move to a 3-week schedule for the herceptin only. I had neoadjuvant TCHP every three weeks and herceptin only every three weeks after that. My MO said I could even do the adjuvant herceptin every four weeks if I wanted.

Edited to add: you are getting a 3x dose if you are getting it every three weeks vs every week. You get the same total amount of Herceptin.

SpecialK · April 2019

You are misreading the dosing instructions, but the way they are worded can be confusing. They state that the Herceptin infusion is to be given with chemo - weekly for 12 weeks if given with paclitaxel (Taxol), OR 18 weeks if given with docetaxel/carboplatin (Taxotere/Carboplatin). The key words are “with chemo" and since the TCH(P) regimen is given every three weeks, the six dosings equal 18 weeks, the TH regimen is given for 12 weeks, with weekly infusion. This is standard and your physician is dosing correctly.

MCMC1 · April 2019

Thank you Hapa, good to hear it's the norm. I am relieved to know.

MCMC1 · April 2019

Thank you SpecialK. The administration guidelines on the Herceptin site specify that for the TCH adjuvent treatment, the drugs Corboplatin and Docetaxel are to be given every 3 weeks for 6 cycles starting week 1, however, Herceptin is to be given weekly for the first 18 weeks (qw = weekly, q3w = every 3 weeks). There's a chart and a diagram to illustrate it. (I'm not allowed to post links on this forum, so please add the Herceptin website address then add the location below right after .com.

"/hcp/treatment/adjuvant/dosing"

Just to give some background information, I am receiving treatment from a public hospital which has a critical shortage of doctors (i.e. at any point in time, this public hospital system that provide free medical care for the entire city is short by 300 doctors) which is public knowledge and is in headline news. After my first cycle of chemotherapy, consisting of IV administration of 3 drugs (Herceptin, Corboplatin, Docetaxel) every 3 weeks for 6 cycles with Herceptin continuing for one year after, I was scheduled for the second cycle injection in 4 weeks instead of 3. When I asked the doctor why there was a 1 week delay, their response was it's because they are short of doctors. I fought with the nurses to schedule me in earlier and luckily they conceded but told me it's a one-time exception. I had to fight again for the timing of my 3rd cycle to be on the 3 week schedule, and luckily they conceded.

This worried me and I wonder if the public hospital doctor bypassed the weekly instructions because of their staff shortage (i.e. it's more labour intensive to give me Herceptin weekly).

Given that HER2 is an aggressive form of cancer, I am worried that derailing from the regime will affect Herceptin's efficacy and increase the chance of recurrence. I don't really have any clout with the public hospital doctors and wonder if I can get help somewhere else, perhaps from pharmaceutical companies, holding doctors responsible for the risks associated with derailing from clinically proven regimens.

SpecialK · April 2019

I have been posting on this site for almost 9 years and have seen many Her2+ patient posts, and am one myself. I have never seen anyone get weekly Herceptin between their Taxotere/Carboplatin infusions, and this was not the way it was done for me either. I had six infusions that consisted of Taxotere, then Carboplatin, then Herceptin. Every one on the Triple Positive thread who had TCH has had it this way also, and that thread has been going for 8 years with thousands of posts. This goes for those being treated at the finest cancer treatment facilities, to UCLA where Dr. Dennis Slamon, the researcher who brought Herceptin to the market, to community hospitals and private cancer treatment centers - Herceptin is thought to work synergistically with the chemo drugs - that is why it is given concurrently with them for the course of chemo, then continued alone. This is the standard of care. I looked at the Herceptin site and looked for the dosing instructions specifically before I posted to you the first time to see if I could see where you might be misreading. The key word are "with" or "during" chemo and the unfortunate use of "weekly" - referring to weekly paclitaxel (Taxol) only - is what is causing confusion. Please don't stress about how your treatment is being dosed, it is correct. There are so many other things to worry about during treatment I am hopeful that you can set this particular worry aside and, aside from the delays and physician shortages, know that you are being treated the way all of us Her2+ patients are on multi-drug regimens. Wishing you the best.

MCMC1 · April 2019

Thank you SpecialK, it is a relief to know what other cancer treatment facilities are doing! Indeed, now I can set this worry aside.

Herceptin Not Given Weekly from Week 2-18

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