Example orders for trastuzumab emtansine (Kadcyla) in breast cancer

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Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.

Ado-trastuzumab emtansine (Kadcyla)

Published regimens and references can be found on the breast cancer page.

Example order set #1

• Ado-trastuzumab emtansine (Kadcyla) 3.6 mg/kg IV over 90 minutes once on cycle 1 day 1; use 0.22 micron inline filter and observe patient for 90 minutes after first dose. Then, Ado-trastuzumab emtansine (Kadcyla) 3.6 mg/kg IV over 30 minutes once on day 1 of subsequent cycles, and observe the patient for 30 minutes after infusion completes.

21-day cycles, given until progression of disease or unacceptable toxicity

Supportive medications:

• Acetaminophen (Tylenol) 650 mg PO once 30 minutes prior to chemotherapy
• Diphenhydramine (Benadryl) 25 mg IV once 30 minutes prior to chemotherapy
• Ondansetron (Zofran) 8 mg PO once 30 minutes prior to chemotherapy

Hydration:

• Normal saline IV continuous infusion at 5 mL/H
• Normal saline 25 to 50 mL IV prn flush before and after chemotherapy

Monitoring/precautions:

• Monitor for thrombocytopenia (however, no mandatory mid-cycle check)

Nursing:

• Patients without central lines: insert peripheral IV before therapy. Flush peripheral IV with 10 mL 0.9% normal saline after each day's dose of chemotherapy. Remove peripheral IV when therapy is complete.
• Patients with central lines: access the central venous access device before therapy. Flush central line according to institutional guidelines after each day's dose of chemotherapy. Deaccess device when therapy is complete.