Trastuzumab Emtansine Chemo Preparation

Some key points to keep in mind while preparing ADO-TRASTUZUMAB EMTANSINE:

1. 1Products are not interchangeable, meaning don’t use different brands preparing the same dose.
2. 2The molecule can cause liver damage, so keep a close eye on the patient liver enzymes.
3. 3Also cardiac damage to be expected,  keep an eye on the ventricular ejection fraction.
4. 4General dosing is 3.6mg per kg every 3 weeks. It’s easy to remember.
5. 5No dosage adjustment for renal patients, however as mentioned before, it can cause damage to the liver, so either reduce the dose or discontinue depending on the damage level done to the patient’s liver.

Some infusion reactions are documented with few cases. If it happened, then either stop the infusion or set the rate as slow as possible. Infusions should be over 90 minutes for the first dose, and if the patient tolerated the dose, then infusion for the following doses can be over no less than 30 minutes. (However, I always advise our nursing staff to always go for the 90 minutes.)

Depending on the reaction type of the reaction severity, the dose should be decreased and patient status is to be monitored, as mentioned, the regular dose is 3.6mg per kg, If this dose induced some reaction/toxicity, next dose should be 3mg per kg, and the following dose is 2.4mg per kg if another reaction took place with the first dose adjustment, however if the reaction still not controlled with the second dose reduction, the treatment should be discontinued and alternative therapy should be pursued.

Drug volume optimization …

• The products doesn’t contain preservatives
• Reconstituted vials are stable for 24 hours in the fridge,2°C to 8°C
• Same for final solutions, the mentioned stability includes infusion time.
• There is no displacement volume,  use 5ml swfi for 100mg vials and 8ml for 160mg vials. Final conc. would be 20mg/ml
• Final solution is crystal clear, like water, there is no particles in it.
• Only use saline, Trastuzumab Emtansine  isn’t compatible with d5w.

nursing tips …

Check the patient for allergic reaction. Review the labs for liver enzymes. Monitor symptoms for heart failure.