Name of the Procedure:

Injection, ado-trastuzumab emtansine, 1 mg Common names: Kadcyla Injection, T-DM1 Injection Medical term: Injection, ado-trastuzumab emtansine, 1 mg (HCPCS Code J9354)

Summary

The injection of ado-trastuzumab emtansine (Kadcyla) is a treatment used mainly for specific types of breast cancer. It combines the targeting mechanisms of a monoclonal antibody (trastuzumab) with the anti-cancer chemotherapy drug emtansine, aiming to kill cancer cells while minimizing damage to healthy cells.

Purpose

Conditions Addressed:

• HER2-positive metastatic breast cancer
• Breast cancer that has spread and does not respond to other HER2 therapies

Goals:

• Shrink cancer tumors
• Inhibit cancer growth
• Prolong patient survival
• Improve quality of life

Indications

Symptoms/Conditions:

• Diagnosed HER2-positive breast cancer
• Metastatic cancer
• Cancer unresponsive to previous HER2-targeted therapies

Patient Criteria:

• HER2-positive status confirmed via specific tests (e.g., IHC and/or FISH tests)
• Prior treatment regimes failed, including trastuzumab and taxane therapies

Preparation

Pre-Procedure Instructions:

• No special dietary restrictions typically required
• Review current medications with healthcare provider; some may need to be adjusted
• Blood tests to check white blood cell count, liver function, and overall health

Required Assessments:

• Cardiac function test (ECHO or MUGA scan)
• Confirmatory biopsy to verify HER2-positive cancer

Procedure Description

Steps:

1. Patient sits in a comfortable chair or lies on an exam bed.
2. An intravenous (IV) line is inserted into a vein.
3. Ado-trastuzumab emtansine (Kadcyla) is infused through the IV over approximately 30-90 minutes.
4. Patient is monitored for any immediate reactions.

Tools/Equipment:

• Sterile IV line and infusion pump
• Kadcyla medication
• Monitoring equipment (heart rate, blood pressure, etc.)

Anesthesia/Sedation:

• Generally, none required as it is an IV infusion

Duration

Typical infusion lasts 30-90 minutes. The procedure may be repeated every three weeks, depending on the treatment plan.

Setting

Performed in a hospital outpatient clinic, cancer center, or specialized infusion center.

Personnel

• Oncologist or specialized oncology nurse to administer the infusion
• Nurse for patient monitoring and support
• Pharmacist for medication preparation

Risks and Complications

Common Risks:

• Nausea
• Fatigue
• Headache
• Fever

• Low platelet counts

  Rare Risks:

• Severe allergic reactions
• Heart problems (congestive heart failure)
• Liver toxicity

Management:

• Pre-medication with anti-nausea drugs
• Regular monitoring of heart and liver function
• Immediate medical intervention for allergic reactions

Benefits

Expected Outcomes:

• Tumor size reduction and slowed cancer progression
• Prolongation of life expectancy in metastatic breast cancer patients
• Improved quality of life and symptomatic relief

Timeline for Benefits:

• Positive outcomes may be observed within months of consistent treatment

Recovery

Post-Procedure Care:

• Patients can usually go home the same day
• Activity levels can often be maintained
• Monitoring for side effects like low blood cell counts and liver function may be required

Recovery Time:

• No significant downtime, but regular follow-ups every three weeks for continued treatment

Restrictions/Follow-Up:

• Avoid exposure to infections due to lowered immunity
• Regular follow-up appointments for blood tests and heart assessments

Alternatives

Other Options:

• Other HER2-targeted therapies (e.g., trastuzumab, pertuzumab)
• Chemotherapy
• Hormonal therapy

Pros and Cons:

• Alternatives may be useful for different patient profiles or stages of treatment
• Kadcyla is often preferred for its double-targeting mechanism, though specific patient conditions will dictate suitability

Patient Experience

During the Procedure:

• Minor discomfort from IV insertion
• Sitting or lying relaxed for an hour or more

After the Procedure:

• Potential mild side effects: fatigue, mild nausea
• Pain management includes over-the-counter remedies for headaches or discomfort
• Supportive care strategies (hydration, rest) recommended