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Treatment Name: TCHP (Taxotere® + Carboplatin + Herceptin® + Perjeta®)

TCHP (Taxotere® + Carboplatin + Herceptin® + Perjeta®) is a Chemotherapy Regimen for Breast Cancer - early stage

How does TCHP work?
Each of the medications in TCHP are designed to kill cancer cells or slow growth of breast cancer cells.

T - Taxotere (docetaxel)
C - Carboplatin
H - Herceptin (trastuzumab)
P - Pertuzumab (Perjeta)

Goals of therapy:
TCHP can given can be given with the goal of cure either before surgery (neoadjuvant) to shrink the size of the tumor, or after surgery (adjuvant) to kill any cancer cells that may be still present in the body.

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Schedule

  • Docetaxel intravenous (I.V.) infusion over 1 hour on Day 1
  • Carboplatin I.V. infusion over 30 minutes on Day 1
  • Trastuzumab I.V. infusion over 90 minutes on Day 1 of Cycle 1
    • then, Trastuzumab I.V. infusion over 60 minutes for Cycle 2
    • then, Trastuzumab I.V. infusion over 30 minutes for Cycles 3 and on if tolerated
  • Pertuzumab I.V. infusion over 60 minutes on Day 1 of Cycle 1, plus a one-hour observation time after the infusion
    • then, Pertuzumab I.V. infusion over 30 minutes on Day 1 of Cycles 2 through 6

Estimated total infusion time for tchp treatment:  

  • Up to 7 hours for Cycle 1
  • Usually four hours for Cycles 2, 3, 4, 5, and 6
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

Click here for common TCHP starting doses.

Typically, docetaxel, carboplatin, trastuzumab, and pertuzumab are all given on Day 1 of each cycle. TCHP is usually given in an outpatient infusion center, allowing the person to go home afterwards.

TCHP chemo is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated up to 6 times, depending upon the stage of the disease. Duration of therapy may last up to 5 to 6 months, depending upon response, tolerability, and number of cycles prescribed.

Once TCHP is completed, trastuzumab is commonly continued alone. It will be given every three weeks for a total of 52 weeks of therapy.

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Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with TCHP are shown here:

  • Diarrhea (72%)
  • Hair loss (54%)
  • Low white blood cells (49%)
  • Nausea (45%)
  • Fatigue (42%)
  • Vomiting (40%)
  • Low red blood cells (37%)
  • Upset stomach (22%)
  • Constipation (16%)
  • Decrease heart function (3%)

Side effect videos Side Effect Videos
DiarrheaDiarrheaHair LossHair LossNausea and VomitingNausea and VomitingFatigue Fatigue AnemiaAnemiaConstipationConstipation

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Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each chemotherapy cycle. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging is checked before treatment and may be also checked after completion of treatment. Imaging may include: magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans. Echocardiograms are typically performed before the first treatment, then periodically thereafter to monitor your heart function.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue TCHP as planned, or delay or switch therapy.

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ChemoExperts Tips

  • Remember to take dexamethasone 8 mg (two 4 mg tablets) by mouth twice daily the day before, the day of infusion, and the day after receiving docetaxel to help prevent excess fluid from staying in your body. If you forget, be sure to alert the doctor, nurse, or pharmacist at the infusion center. An intravenous dose of dexamethasone may be given if you forget any doses at home
  • Be prepared to stay at the infusion center longer than planned if any infusion reactions occur to any of these drugs. Most infusion centers try to start this treatment early in the morning to allow extra time during the day for unexpected delays
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for breast cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with TCHP (Taxotere® + Carboplatin + Herceptin® + Perjeta®)

Individual Drug Label Information

Taxotere® (Docetaxel)

  • Taxotere ​is an intravenous (I.V.) infusion
  • There is an increased  chance of death in patients treated with this drug who have poor liver function, are treated with higher doses, in patients with non-small cell lung cancer and a history of using other “platinum-based chemotherapy” drugs
  • Docetaxel should not be given when a certain blood cell count, neutrophils, get below 1500 cells.  The physician may hold therapy or reduce the dose and continue treatment if this occurs
  • Dosage adjustment may be required for poor liver function
  • Severe fluid retention may occur, especially when combined with prednisone
  • Docetaxel may interact with strong CYP3A4 inhibitors (e.g. ketoconazole) and proteosome inhibitors (e.g. Ritonavir) may increase concentrations of docetaxel and lead to increased toxicity or side effects. More frequent laboratory monitoring and docetaxel dosage adjustment may be needed
  • Severe hypersensitivity may occur, although rare
General Taxotere (Docetaxel) Side Effects
  • Hair loss
  • Low red blood cell count and fatigue
  • Nausea/vomiting
  • Diarrhea
  • Low white blood cell count and associated infections. Blood cell counts, including neutrophils (ANC) should be checked regularly
  • Nail changes on fingers and toes
  • Loss of sensation
  • Swelling in the extremities
  • Mouth sores 
  • Changes in taste
  • Loss of appetite
  • Shortness of breath
  • Muscle pain
  • Tearing of eyes or vision problems
  • Heart problems
  • Click on the taxotere (Docetaxel) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Carboplatin (Paraplatin®)

  • Carboplatin is an intravenous infusion 
  • This medication is dosed based on your kidney function. If your kidney function improves or worsens during therapy, your dose may need to be adjusted
  • This drug should not be used during pregnancy, it may cause fetal harm
General Carboplatin (Paraplatin) Side Effects:  
  • Low red blood cells, low white blood cells, and most commonly, low platelets can be occur
  • Nausea and vomiting is common but can be prevented by taking certain pre-medications
  • Hair loss
  • Constipation and/or diarrhea
  • Pain
  • Allergic reactions to carboplatin can occur. These typically are not seen until after the 6th dose of carboplatin is given 
  • Can cause liver damage at high doses 
  • May cause kidney damage or hearing loss if combined with other medications that also cause these side effects 
  • Click on the carboplatin (Paraplatin) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossBleedingBleedingConstipationConstipationPainPainAnemiaAnemia

See DailyMed package insert.

Herceptin® (Trastuzumab)

  • Herceptin is an intravenous infusion 
  • Your heart function should be checked before starting trastuzumab and every 3 months while on therapy. If your heart's ability to pump decreases, treatment may need to be interrupted for a period of time to let your heart function to improve. You may also be started on several medications to help improve your heart function 
  • Although rare, severe lung toxicity. The risk of this side effect is increased in patients with various lung diseases who receive trastuzumab 
  • May cause severe birth defects when given to pregnant women. Use proper birth control methods while on trastuzumab and notify your doctor if you become pregnant during therapy 
General Trastuzumab (Herceptin) Side Effects 
  • Can cause infusion reactions that most likely occur during the first infusion. If these occur, you may need to receive acetaminophen, diphenhydramine, and a corticosteroid before all future doses 
  • May cause skin rash 
  • May cause persistent cough, runny nose, or trouble breathing 
  • Click on the trastuzumab (Herceptin) package insert below for reported side effects and possible drug interactions
See DailyMed package insert.

Pertuzumab (Perjeta®)

  • Pertuzumab is an intravenous infusion 
  • Your heart function should be checked before starting pertuzumab and every 3 months while on therapy. If your heart's ability to pump decreases, treatment may need to be interrupted for a period of time to let your heart function to improve. You may also be started on several medications to help improve your heart function 
  • May cause severe birth defects when given to pregnant women. Use proper birth control methods while on pertuzumab and notify your doctor if you become pregnant during therapy 
General Pertuzumab (Perjeta) Side Effects  
  • Can cause infusion reactions that most likely occur during the first infusion. If these occur, you may need to receive acetaminophen, diphenhydramine, and a corticosteroid before all future doses. Typically, patients are observed for 30-60 minutes after each infusion is finished to monitor for any reactions
  • Frequently causes significant diarrhea. This can be managed with over-the-counter medications such as loperamide, or a prescription medication such as Lomotil (diphenoxylate + atropine)
  • May cause skin rash 
  • Click on the pertuzumab (Perjeta) package insert for reported side effects and possible drug interactions

Side Effect Videos
DiarrheaDiarrheaFatigue Fatigue

See DailyMed package insert.

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References

Schneeweiss A, Chia S, Hickish T, et al. Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA). Annals of Oncology. 2013;24:2278–2284.

Created: October 21, 2015 Updated: August 30, 2016

What is Breast Cancer - early stage?

What is Early Stage Breast Cancer?
A disease of either the milk-producing glands known as lobules, or milk ducts, or other cells found in the breast. Early stage breast cancer may also affect the lymph nodes, but has not usually spread to other areas of the body. Breast cancer is the most common type of cancer diagnosed in women, but may rarely affect men as well. Breast cancer cells may have increased expression of estrogen receptors (ER positive or negative), progestin receptors (PR positive or negative), and/or HER-2 receptors (HER-2 positive or negative). The presence or lack of these receptors will help determine the most effective chemotherapy medications to give.

Genetic causes, such as the BRCA (pronounced "Bracka") mutation, significantly increase the risk of developing breast cancer. Other risk factors for breast cancer include family history of breast cancer, high fat diet, and obesity. The stage of breast cancer can vary at diagnosis and throughout treatment. Stages of breast cancer include I, II, III, and IV. The effectiveness of the treatment may depend upon the stage at diagnosis.

Types of breast cancer:
1. Hormone-receptor positive or negative (60 - 65% of patients)

  • Estrogen Receptor positive (ER)+ or negative (ER)-
  • Progestin Receptor positive (PR)+ or negative (PR)-

2. Hormone Epidermal growth factor Receptor-2 (HER-2) positive or negative (20 - 25% of patients)

  • HER-2 + (positive)
  • HER-2 -  (negative)

3. Triple Negative (15 - 18% of patients)

  • ER- and PR- and (HER-2)-

Patients can have combinations of these types listed and each treatment uses different drugs.

Common Starting Doses

  • Docetaxel 75 mg/m2 IV infusion over 1 hour on Day 1
  • Carboplatin AUC 6, IV infusion over 30 minutes on Day 1
  • Trastuzumab 8 mg/kg IV infusion over 90 minutes on Day 1 of Cycle 1 - loading dose
    • then, Trastuzumab 6 mg/kg IV over 60 minutes on Cycle 2 (if tolerated)
    • then, Trastuzumab 6 mg/kg IV over 30 minutes on Cycles 3 through 6 (if tolerated)
  • Pertuzumab 840 mg IV infusion over 60 minutes on Day 1 of Cycle 1 (plus 60 min. post-infusion observation) - loading dose
    • then, Pertuzumab 420 mg IV infusion over 30 minutes on Day 1 of Cycles 2 through 6

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

1. Coiffier B, L epage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346:235-242.
2. Habermann TM, Weller EA, Morrison VA, et al. Rituximab-CHOP versus CH OP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. J Clin Oncol. 2006;24:3121-3127.
3. Flinn IW, van der Jagt R, Kahl BS, et al. Randomized trial of bendamustine-rituximab or R-CHOP/R-C VP in first-line treatment of indolent NH L or MCL : the BRIGHT study. Blood. 2014;123:2944-2952.
4. Pfreundschuh M1, Müller C, Zeynalova S et al. Suboptimal dosing of rituximab in male and female patients with DLBCL. Blood. 2014; 123:640-646.