Planning for treatment before surgery

Based on your answers, here is information about starting HER2-targeted therapy.  

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As you read your results, look out for underlined words that you can click on to see the term defined.

At least one of the following is true:

  • I have been diagnosed with breast cancer
  • The tumor is node positive, inflammatory, or larger than two centimeters
  • I will be receiving neoadjuvant treatment before surgery
Clear and start over

The goal of HER2-targeted treatment before surgery is to remove as many cancer cells as possible

Your doctor may recommend one of the following:

Who may be eligible for PERJETA or PHESGO?

People with HER2+, locally advanced, inflammatory, or early stage breast cancer (either greater than 2 cm in diameter or node positive).

Perjeta® (pertuzumab)

PERJETA is given with another HER2‑targeted treatment called Herceptin® (trastuzumab) and chemotherapy. PERJETA and Herceptin are intravenous (IV) infusions that are given back-to-back in about 1-2.5 hours.*

PHESGO® (pertuzumab, trastuzumab, and hyaluronidase-zzxf)

PHESGO brings together PERJETA and Herceptin in a single injection just under the skin. It is given with chemotherapy. The first dose of PHESGO takes about 8 minutes. After that, receiving PHESGO takes about 5 minutes.*

Please see full Prescribing Information for additional Important Safety Information, including most serious side effects, for PERJETA and PHESGO.

Stay on this page to learn about these treatments and how they may be able to help.

*This does not account for observation time and other aspects of treatment. Actual clinic time may vary.

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Remember, this site is for educational purposes only. Your primary sources of information should always be your doctor and the professionals who make up your healthcare team. Only they can give you medical advice about HER2+ early breast cancer and treatment.

If your doctor recommends PERJETA + Herceptin before surgery

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Both PERJETA and Herceptin are HER2-targeted therapies that work alongside chemotherapy to treat HER2+ breast cancer.

A study compared the effectiveness of  PERJETA + Herceptin before surgery to a different neoadjuvant treatment

Who was in the study?

417 people with certain types of HER2+ early breast cancer receiving treatment before surgery (neoadjuvant treatment).

What was the goal of the study?

To see if people who received PERJETA + Herceptin + chemotherapy treatment before surgery (neoadjuvant) were more likely to have no detectable cancer cells after surgery.

What were the results?

Almost twice as many people who got PERJETA + Herceptin before surgery had no detectable cancer cells in the lymph nodes and breast tissue removed during surgery, compared with people who got the other treatment.

39.3% of people (42 out of 107 people) who received this treatment achieved a pCR
21.5% of people (23 out of 107 people) who received the other treatment achieved a pCR
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What are the most serious side effects of PERJETA?

  • PERJETA may cause heart problems, including those without symptoms (such as reduced heart function) and those with symptoms (such as congestive heart failure).
  • Receiving PERJETA during pregnancy can result in the death of an unborn baby and birth defects.

What are other possible serious side effects of PERJETA?

PERJETA should not be used in patients who are allergic to pertuzumab or to any of the ingredients in PERJETA. Possible serious and sometimes fatal side effects of PERJETA include infusion-related reactions and severe allergic reactions (hypersensitivity reactions/anaphylaxis).

See additional Important Safety Information below.

Dosing schedule for PERJETA + Herceptin when starting treatment before surgery

The dosing schedule for PERJETA is organized by cycle. For example, PERJETA is given once every 3 weeks. That is 1 cycle.

1 cycle every 3 weeks for up to 18 cycles

People who are eligible may receive 3-6 cycles (9-18 weeks) of PERJETA and Herceptin before surgery, unless side effects cause the treatment to be stopped sooner. You will also be given chemotherapy, but the dosing schedule and number of cycles will depend on which type of chemotherapy you receive.

If your doctor recommends PHESGO before surgery

Injection icon

PHESGO—a combination with PERJETA and Herceptin in a single ~5 minute injection under the skin.* PHESGO is given as part of a complete treatment regimen for HER2+ breast cancer that includes chemotherapy.

If you’re receiving PERJETA + Herceptin, your doctor may be able to switch you to PHESGO if they think it’s right for you.

*Your first dose is given in ~8 minutes. This does not account for observation time and other aspects of treatment. Actual clinic time may vary.

A study looked to see if people who got PHESGO had the same results as those who received PERJETA + Herceptin

Who was in the study?

500 people with certain types of HER2+ early breast cancer.

  • Everyone in the study also received chemotherapy as part of a complete treatment regimen
What was the goal of the study?

To find out if there were any differences between PHESGO and PERJETA + Herceptin.

How was this determined?

The study measured the amount of medicine in the bloodstream, which is commonly done to check that the injection works like the infusion. The study also looked at how safe the drug was and if it worked on the cancer.

What were the results?

No major difference was seen in the amount of medicine that went into the bloodstream with PHESGO compared to PERJETA + Herceptin.

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The combined results of the study showed no major difference is expected in how PHESGO works.

Another study comparing PERJETA + Herceptin and PHESGO focused on patient preference

Who was in the study?

160 people with certain types of HER2+ early breast cancer.

What was the goal of the study?

To find out if people preferred one treatment over the other.

How was this determined?

All participants were given IV PERJETA + Herceptin + chemotherapy before surgery. After surgery, some were given 3 cycles of IV PERJETA + Herceptin then 3 cycles of PHESGO. Others were given PHESGO first then IV PERJETA + Herceptin. Everyone completed a total of 18 cycles of treatment. Patients were asked which treatment they preferred after they completed 6 cycles.

What were the results?

More people preferred PHESGO over PERJETA + Herceptin

85% preferred PHESGO, 14% preferred IV PERJETA + Herceptin, and 1% had no preference
  • Preferred PHESGO (n=136)
  • Preferred IV PERJETA + Herceptin (n=22)
  • No preference (n=2)

The most common reason people preferred PHESGO was because it took less time in the clinic.

The most common reason people preferred IV PERJETA + Herceptin was because it felt more comfortable during administration.

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What are the most serious side effects of PHESGO?

  • PHESGO may cause heart problems, including those without symptoms (such as reduced heart function) and those with symptoms (such as congestive heart failure).
  • Receiving PHESGO during pregnancy can result in the death of an unborn baby and birth defects.
  • PHESGO may cause serious lung problems.

Who should not receive PHESGO?

PHESGO should not be used in patients who are allergic to pertuzumab, trastuzumab, hyaluronidase, or to any of the ingredients in PHESGO.

What are other possible serious side effects?

  • PHESGO may worsen low white blood cell counts caused by chemotherapy
  • PHESGO may cause administration-related reactions, including hypersensitivity or anaphylaxis, which can be fatal

See additional Important Safety Information below.

Dosing schedule for PHESGO when starting treatment before surgery

The dosing schedule for PHESGO is organized by cycle. For example, PHESGO is given once every 3 weeks. That is 1 cycle.

1 cycle every 3 weeks for up to 18 cycles

People who are eligible may receive 3-6 cycles (9-18 weeks) of PHESGO before surgery, unless side effects cause the treatment to be stopped sooner. You will also be given chemotherapy, but the dosing schedule and number of cycles will depend on which type of chemotherapy you receive.

Understanding the differences between treatments

 

 

PERJETA + Herceptin

PHESGO
What active ingredients are in the treatment?

Pertuzumab
Trastuzumab

Pertuzumab
Trastuzumab
Hyaluronidase
How does one receive treatment?

Intravenous (IV) infusion, given by a healthcare provider

Subcutaneous (under the skin) injection, given by a healthcare provider
How much time will it take to receive treatment?

About 1-2.5 hours: 

  1. PERJETA infusions take 30-60 minutes
  2. Herceptin infusions take 30- 90 minutes

This does not account for observation time and other aspects of treatment. Actual clinic time may vary.

Your first dose is given in about 8 minutes. Other injections take about 5 minutes.

This does not account for observation time and other aspects of treatment. Actual clinic time may vary.
How do these treatments compare?

A study comparing PHESGO to PERJETA + Herceptin found no major difference is expected in how well PHESGO works. By taking PHESGO, you're taking the same medicines, just in less time.
What about side effects?

There are side effects associated with both treatments. The comparison study did not find any significant difference between the 2 treatments.
Dictionary icon

As you read your results, look out for underlined words that you can click on to see the term defined.

At least one of the following is true:

  • I have been diagnosed with breast cancer
  • The tumor is node positive, inflammatory, or larger than two centimeters
  • I will be receiving neoadjuvant treatment before surgery
Clear and start over
With HER2+ Early Breast Cancer, Knowledge is Empowering
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You can start the conversation

We want to help provide you with the information you need to feel empowered throughout your treatment for HER2+ EBC.

Here are some starter questions to begin a conversation with your doctor or healthcare team:

  • Am I a good candidate for neoadjuvant therapy?
  • Is treatment with PHESGO right for me?
  • How is PHESGO different from PERJETA+ Herceptin?
  • How is PHESGO given?
  • How is PERJETA + Herceptin given?
  • Can I switch from PERJETA + Herceptin to PHESGO?
Download the discussion guide
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See the decision points that lead to a doctor’s recommendation about EBC treatment
Explore the treatment experience
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Explore these HER2-targeted therapies
Visit PHESGO.com
Visit PERJETA.com
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Important Safety Information & Uses

PERJETA

PHESGO

What does PERJETA treat?

PERJETA® (pertuzumab) is a prescription medicine approved for use in combination with Herceptin® (trastuzumab) and chemotherapy for:

  • use prior to surgery (neoadjuvant treatment) in people with HER2-positive, locally advanced, inflammatory, or early stage breast cancer (tumor is greater than 2 cm in diameter or node-positive). PERJETA should be used as part of a complete treatment regimen for early breast cancer. 

  • use after surgery (adjuvant treatment) in people with HER2-positive early breast cancer that has a high likelihood of coming back.

What should I know about side effects with PERJETA?

  • Not all people have serious side effects; however, side effects with PERJETA therapy are common. It is important to know what side effects may happen and what symptoms you should watch for

  • Your doctor may stop treatment if serious side effects happen. Be sure to contact your healthcare team right away if you have questions or are worried about any side effects

What are the most serious side effects of PERJETA?

PERJETA may cause heart problems, including those without symptoms (such as reduced heart function) and those with symptoms (such as congestive heart failure).

  • Your doctor may run tests to monitor your heart function before and during treatment with PERJETA

  • Based on test results, your doctor may hold or discontinue treatment with PERJETA

  • Contact a health care professional immediately for any of the following: new onset or worsening shortness of breath, cough, swelling of the ankles/legs, swelling of the face, palpitations, weight gain of more than 5 pounds in 24 hours, dizziness or loss of consciousness

Receiving PERJETA during pregnancy can result in the death of an unborn baby and birth defects.

  • Birth control should be used while receiving PERJETA and for 7 months after your last dose of PERJETA. If you are a mother who is breastfeeding, you should talk with your doctor about either stopping breastfeeding or stopping PERJETA

  • If you think you may be pregnant, you should contact your healthcare provider immediately

  • If you are exposed to PERJETA during pregnancy, or become pregnant while receiving PERJETA or within 7 months following the last dose of PERJETA in combination with Herceptin, you are encouraged to report PERJETA exposure to Genentech at 1-888-835-2555

What are other possible serious side effects?

  • PERJETA should not be used in patients who are allergic to pertuzumab or to any of the ingredients in PERJETA

  • Infusion-related reactions: PERJETA is a medicine that is delivered into a vein through a needle. PERJETA has been associated with infusion-related reactions, some fatal. The most common infusion-related reactions when receiving PERJETA, Herceptin, and docetaxel were feeling tired, abnormal or altered taste, allergic reactions, muscle pain, and vomiting. The most common infusion-related reactions when receiving PERJETA alone were fever, chills, feeling tired, headache, weakness, allergic reactions, and vomiting

  • Severe allergic reactions: Some people receiving PERJETA may have severe allergic reactions, called hypersensitivity reactions or anaphylaxis, which may happen quickly and may affect many areas of the body. Severe allergic reactions, some fatal, have been observed in patients treated with PERJETA

What are the most common side effects?

The most common side effects of PERJETA when given with Herceptin and chemotherapy as part of an early breast cancer regimen before surgery are:

  • Constipation

  • Damage to the nerves (numbness, tingling, pain in hands/feet) 

  • Diarrhea

  • Feeling tired 

  • Hair loss 

  • Headache

  • Low levels of red blood cells 

  • Low levels of white blood cells with or without fever 

  • Low platelet count 

  • Mouth blisters or sores 

  • Nausea

  • Pain in the muscles 

  • Vomiting

  • Weakness 

Side effects may vary based on chemotherapy regimen.

The most common side effects of PERJETA when given with Herceptin and chemotherapy as part of an early breast cancer regimen after surgery are:

  • Diarrhea 

  • Nausea 

  • Hair Loss 

  • Feeling tired 

  • Damage to the nerves (numbness, tingling, pain in hands/feet)

  • Vomiting

You are encouraged to report side effects to Genentech and the FDA. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.

Talk to a healthcare professional for more information about the benefits and risks of PERJETA.

Please see full Prescribing Information for additional Important Safety Information, including most serious side effects.

If you cannot afford your medication, visit genentech-access.com/patient for financial assistance information.

What does PHESGO treat?

PHESGO® (pertuzumab, trastuzumab, and hyaluronidase-zzxf) is a prescription medicine approved for use in combination with chemotherapy for:

  • use prior to surgery (neoadjuvant treatment) in adults with HER2-positive, locally advanced, inflammatory, or early stage breast cancer (tumor is greater than 2 cm in diameter or node-positive). PHESGO should be used as part of a complete treatment regimen for early breast cancer. 

  • use after surgery (adjuvant treatment) in adults with HER2-positive early breast cancer that has a high likelihood of coming back.

What should I know about side effects with PHESGO?

  • Not all people have serious side effects; however, side effects with PHESGO therapy are common. It is important to know what side effects may happen and what symptoms you should watch for

  • Your doctor may stop treatment if serious side effects happen. Be sure to contact your healthcare team right away if you have questions or are worried about any side effects

What are the most serious side effects of PHESGO?

PHESGO may cause heart problems, including those without symptoms (such as reduced heart function) and those with symptoms (such as congestive heart failure).

  • The risk for and seriousness of these heart problems are highest in people who received both PHESGO and a certain type of chemotherapy (anthracycline)

  • Your doctor will check for signs of heart problems before, during, and after treatment with PHESGO. Based on test results, your doctor may hold or discontinue treatment with PHESGO

  • Contact a healthcare professional immediately for any of the following: new onset or worsening shortness of breath, cough, swelling of the ankles/legs, swelling of the face, palpitations, weight gain of more than 5 pounds in 24 hours, dizziness or loss of consciousness

Receiving PHESGO during pregnancy can result in the death of an unborn baby and birth defects.

  • Birth control should be used while receiving PHESGO and for 7 months after your last dose of PHESGO. If you are a mother who is breastfeeding, you should talk with your doctor about either stopping breastfeeding or stopping PHESGO

  • If you think you may be pregnant, you should contact your healthcare provider immediately

  • If you are exposed to PHESGO during pregnancy, or become pregnant while receiving PHESGO or within 7 months following the last dose of PHESGO, you are encouraged to report PHESGO exposure to Genentech at 1-888-835-2555

PHESGO may cause serious lung problems.

  • Your doctor may check for signs of lung problems including:

    • Severe shortness of breath

    • Fluid in or around the lungs

    • Weakening of the valve between the heart and the lungs

    • Not enough oxygen in the body

    • Swelling of the lungs

    • Scarring of the lungs

Who should not receive PHESGO?

  • PHESGO should not be used in patients who are allergic to pertuzumab, trastuzumab, hyaluronidase, or to any of the ingredients in PHESGO

What are other possible serious side effects?

  • PHESGO may worsen low white blood cell counts caused by chemotherapy: Low white blood cell counts can be life threatening and were seen more often in patients receiving Herceptin® (trastuzumab) plus chemotherapy than in patients receiving chemotherapy alone. Your doctor may check for signs of low white blood cell counts when he or she examines you 
  • PHESGO may cause administration-related reactions: PHESGO is given as an injection. The active ingredients in PHESGO have been associated with severe administration reactions, including hypersensitivity or anaphylaxis, which can be fatal. Talk to your doctor if you feel any symptoms. The most common symptoms include dizziness, nausea, chills, fever, vomiting, diarrhea, hives, swelling of the skin, breathing problems, or chest pain

What are the most common side effects?

The most common side effects of PHESGO when given with chemotherapy as part of an early breast cancer regimen are:

  • Hair Loss

  • Nausea

  • Diarrhea

  • Low levels of red blood cells

  • Weakness

You are encouraged to report side effects to Genentech and the FDA. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.

Talk to a healthcare professional for more information about the benefits and risks of PHESGO.

Please see full Prescribing Information for additional Important Safety Information, including most serious side effects.

If you cannot afford your medication, visit genentech-access.com/patient for financial assistance information.

  • Adjuvant treatment

    The treatment that is given after surgery to kill any remaining cancer cells and lower your risk of the cancer returning. The goal of adjuvant treatment is to keep you cancer-free for as long as possible.

  • Chemotherapy

    A type of medication that kills cells that grow and divide rapidly, including cancer cells and normal cells.

  • Cycle

    A cycle is a course of treatment that is repeated on a regular schedule with periods of rest in between.

  • HER2 status

    HER2 stands for human epidermal growth factor receptor 2. HER2 is a type of protein found on the surface of cells in everyone that tells the cells to grow and divide. When breast cancer cells have too many HER2 receptors, they are called HER2-positive (HER2+).

  • Inflammatory

    When the breast is swollen, red, or inflamed as a result of the cancer cells blocking lymph vessels.

  • Infusion

    A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion.

  • Lymph nodes

    Small, bean-shaped organs found throughout the body that store white blood cells and help remove cell waste, germs, and other harmful substances from the body.

  • Node positive

    This means your doctor has detected cancer cells in one or more of your lymph nodes.

  • Nodal status

    Cancer cells can sometimes appear in nearby structures known as "lymph nodes." When cancer cells appear in one or more lymph nodes, the cancer is said to be "node-positive" (node+).

  • Neoadjuvant treatment

    Treatment given before surgery to help reduce or get rid of cancer cells before surgery.

  • Pathologic complete response (pCR)

    A pCR means that no cancer cells were found in the tissue removed during surgery. A pCR is not the same as a cure.

  • Port

    A surgically implanted disc through which blood can be taken and medication can be given without repeated needle sticks

  • Residual disease

    If cancer cells are found in the tissue removed during surgery, it is known as residual disease.

  • Targeted therapies

    Designed to target specific characteristics of cancer cells. Targeted treatments may also affect normal cells

  • Tumor size

    The size of the tumor is how large it is at its widest point.

  • Hormone receptor status

    Two hormones naturally made by the body are called estrogen and progesterone. These hormones attach to hormone receptors on cells. Some tumors have hormone receptors—they can have estrogen receptors, progesterone receptors, or both. This is called “hormone receptor-positive” breast cancer. “Hormone receptor-negative” breast cancer is when the cancer cells do not have hormone receptors.

  • Hyaluronidase

    Hyaluronidase is a protein naturally found in most tissues of the body and helps enhance the way the body absorbs medicines injected under the skin. When PHESGO is injected, the hyaluronidase makes the tissue under the skin more absorbent temporarily so that it’s able to receive the medication.

  • Locally advanced

    Cancer that has spread from where it started to nearby tissue or lymph nodes.

  • Early-stage breast cancer

    Breast cancer that has not spread beyond the breast or the axillary lymph nodes.

  • HER2-targeted therapies

    A type of targeted cancer treatment that binds to HER2 receptors to fight cancer cells that have too many HER2 receptors.