T-DM1 infusion day: what fourteen cycles look like

T-DM1, also called trastuzumab emtansine or Kadcyla, is given as a drip into a vein in a hospital day-care unit, once every three weeks. After surgery, for people whose cancer was not fully cleared by chemotherapy before the operation, the usual plan is fourteen of these visits, which takes a little under a year. In advanced cancer, visits continue for as long as the treatment is working and side effects are manageable. Each visit follows a similar pattern. You are weighed, because the dose depends on your body weight. A blood sample is checked, mainly your platelet count and liver tests, to make sure it is safe to go ahead. A nurse asks how you have been since the last dose, including any bleeding, tingling, breathlessness or tiredness. The pharmacy then prepares your dose, which can take some time. The first infusion is given slowly, over about an hour and a half, and you are watched for around the same time afterwards in case of a reaction. If that goes well, later infusions usually run over about half an hour, with a shorter wait afterwards. A heart scan is also repeated every few months. Most people can go home the same day and many travel back independently, though having a companion for the first visit is helpful. Knowing the routine makes the day less stressful.

A day-care visit every three weeks

There is no overnight stay, and most of the time is spent on checks and waiting for the pharmacy.

The first visit takes longest

The slower first drip and longer observation mean you should plan for most of the day.

Later visits are shorter

If you cope well, the drip runs faster and the wait afterwards is shorter.

The drip itself is short, but the whole visit often is not. Being prepared helps you manage the day.

Waiting is part of it

Blood results and pharmacy preparation can take longer than expected, especially on busy days.

Plans can change on the day

If your blood tests or symptoms are not right, your dose may be postponed. This can be frustrating, but it protects you.

Fourteen visits is a long commitment

Most of a year of three-weekly visits affects work, travel and family life. It is reasonable to feel worn down at times.

What this page cannot tell you

It cannot tell you the exact routine at your hospital, or how you personally will feel after each dose. Your unit can explain their process.

Most infusions pass without any problem. Reactions are most likely during the first dose, and nurses are trained to deal with them quickly.

Signs of a reaction

Tell the nurse at once if you feel hot, flushed, shivery, breathless, dizzy, or notice a racing heartbeat or chest tightness. The drip can be slowed or paused.

Problems at the drip site

Pain, stinging, redness or swelling around the cannula can mean the medicine is leaking under the skin. Say so immediately so the drip can be stopped and checked.

After you get home

Mild tiredness, headache or nausea over the next few days is common. Call your team for fever, bleeding that will not stop, or breathlessness.