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Kadcyla 160mg Vial
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Indications & Clinical Uses
- Kadcyla 160 mg is a single-dose vial of ado-trastuzumab emtansine (written as trastuzumab emtansine in Europe), a HER2-targeted antibody-drug conjugate given only in hospital as an intravenous infusion by a cancer specialist.
- It treats HER2-positive breast cancer in adults in two settings: unresectable locally advanced or metastatic disease in people already treated with trastuzumab and a taxane, and adjuvant treatment of early breast cancer when invasive disease remains after neoadjuvant taxane and trastuzumab-based therapy.
- The usual dose is 3.6 mg/kg every three weeks.
- Kadcyla must never be substituted for or with trastuzumab (Herceptin), and it is not the same medicine as fam-trastuzumab deruxtecan (Enhertu); these three HER2 medicines have different doses and different toxicities and mix-ups have caused serious harm.
- Kadcyla is currently authorised in both the United States and the European Union.
Side Effects
- Very common reactions to Kadcyla include tiredness (about 36 to 50 in 100 people), nausea (about 40 in 100), muscle and joint pain, headache, constipation, bleeding such as nosebleeds, low platelet counts and raised liver enzymes.
- Kadcyla carries a BOXED WARNING for hepatotoxicity, cardiac toxicity and embryo-fetal toxicity: serious liver injury including liver failure and death has occurred, the heart's pumping function (left ventricular ejection fraction) can fall, and exposure during pregnancy can harm the unborn baby.
- Tell your care team at once about yellowing of the skin or eyes, dark urine, pain under the right ribs, unusual bruising or bleeding, new or worsening breathlessness, cough, swollen ankles, a fast or irregular heartbeat, or numbness and tingling in the hands and feet.
- Infusion reactions such as flushing, chills, fever and wheeze can occur, so tell the nurse immediately if you feel unwell during treatment.
Precautions & Warnings
- Blood tests for liver enzymes and bilirubin and a platelet count are needed before Kadcyla is started and before every dose, and heart function must be assessed by echocardiogram or MUGA scan before treatment and regularly during it.
- Treatment is withheld or reduced for significant liver or heart changes, and stopped permanently for interstitial lung disease, pneumonitis or nodular regenerative hyperplasia of the liver.
- Kadcyla is for intravenous infusion only, never as an intravenous push or bolus, and the infusion site is watched for extravasation.
- Pregnancy must be excluded before treatment; use effective contraception during treatment and for seven months after the final dose, and do not breastfeed.
- Tell the team if you have liver disease, hepatitis B or C, heart failure or peripheral neuropathy.
- Vials are stored refrigerated at 2°C to 8°C by the pharmacy, which also reconstitutes and dilutes them; patients never handle the product.
Avoid Interactions
- Kadcyla toxicity can be increased by strong CYP3A4 inhibitors such as ketoconazole, itraconazole, clarithromycin, telithromycin, ritonavir, nefazodone, atazanavir, indinavir, nelfinavir and saquinavir, because they slow clearance of the DM1 component; these should be avoided where possible and an alternative chosen.
- Bleeding risk rises when Kadcyla is combined with anticoagulants such as warfarin or heparin, or with antiplatelet medicines including aspirin and clopidogrel, so platelet counts are watched closely.
- Anthracyclines given close to Kadcyla add to the risk of heart damage.
- Kadcyla must not be mixed with other medicines and must not be diluted in dextrose (glucose) solution, which causes protein aggregation; only sodium chloride solutions are used.
- Tell your care team about every prescription medicine, herbal product such as St John's wort, and supplement you take, and check with them before having any vaccination.
References
Frequently Asked Questions
Kadcyla (ado-trastuzumab emtansine) treats HER2-positive breast cancer in adults. It is used for metastatic disease after trastuzumab and a taxane, and after surgery when invasive cancer remains following neoadjuvant treatment. A cancer specialist gives it as an intravenous infusion, 3.6 mg/kg every three weeks.
Kadcyla is given as an intravenous infusion in hospital, 3.6 mg/kg every three weeks. The first infusion takes about 90 minutes and later ones about 30 minutes if tolerated. It is never given as a rapid injection or bolus, and staff watch you during and after each dose.
Common Kadcyla side effects are tiredness, nausea, headache, constipation, muscle and joint pain, nosebleeds, low platelets and raised liver enzymes. Its boxed warning covers liver injury, reduced heart pumping function and harm to an unborn baby. Report yellow skin or eyes, unusual bruising, breathlessness or swollen ankles urgently.
Avoid strong CYP3A4 inhibitors such as ketoconazole, itraconazole, clarithromycin and ritonavir while on Kadcyla (ado-trastuzumab emtansine), as they can raise toxicity. Use aspirin, clopidogrel and blood thinners only with advice, because bleeding risk rises. The infusion must never be diluted in dextrose, and pregnancy must be avoided.
Before every Kadcyla dose you have blood tests for liver enzymes, bilirubin and platelets, and your heart's pumping function is checked by echocardiogram or MUGA scan before treatment and regularly during it. Doses are delayed, reduced or stopped if liver, heart or platelet results change significantly.
No. Kadcyla (ado-trastuzumab emtansine) must never be substituted for or with trastuzumab (Herceptin), and it is not the same as fam-trastuzumab deruxtecan (Enhertu). The three medicines have different doses and different toxicities, and confusing them has caused serious harm. Check the full name on every prescription and vial.
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