Step-by-step tutorial for preparing and administering PHESGO
The purpose of this video is to help educate on how to properly administer PHESGO. For full information on dosing considerations, dose modifications and monitoring, and complete administration information, please review the PHESGO full Prescribing Information.
Indications
Early Breast Cancer
PHESGO™ (pertuzumab, trastuzumab, and hyaluronidase-zzxf) is indicated for use in combination with chemotherapy for
- the neoadjuvant treatment of adult patients with HER2-positive, locally advanced, inflammatory, or early stage breast cancer (either greater than 2 cm in diameter or node-positive) as part of a complete treatment regimen for early breast cancer (EBC)
- the adjuvant treatment of adult patients with HER2-positive early breast cancer (EBC) at high risk of recurrence
Select patients for therapy based on an FDA-approved companion diagnostic test.
Metastatic Breast Cancer
PHESGO is indicated for use in combination with docetaxel for the treatment of adult patients with HER2-positive metastatic breast cancer (MBC) who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease.
Select patients for therapy based on an FDA-approved companion diagnostic test.
Important Safety Information
BOXED WARNINGS: Cardiomyopathy, Embryo-Fetal Toxicity, and Pulmonary Toxicity
- PHESGO administration can result in subclinical and clinical cardiac failure. The incidence and severity was highest in patients receiving PHESGO with anthracycline-containing chemotherapy regimens. Evaluate cardiac function prior to and during treatment with PHESGO. Discontinue PHESGO treatment in patients receiving adjuvant therapy and withhold PHESGO in patients with metastatic disease for clinically significant decrease in left ventricular function
- Exposure to PHESGO can result in embryo-fetal death and birth defects, including oligohydramnios and oligohydramnios sequence manifesting as pulmonary hypoplasia, skeletal abnormalities, and neonatal death. Advise patients of these risks and the need for effective contraception
- PHESGO administration can result in serious and fatal pulmonary toxicity. Discontinue PHESGO for anaphylaxis, angioedema, interstitial pneumonitis, or acute respiratory distress syndrome. Monitor patients until symptoms completely resolve
Perform HER2 testing using FDA-approved tests by laboratories with demonstrated proficiency.
Dosing schedules
- Metastatic breast cancer: administer PHESGO by subcutaneous injection and docetaxel by intravenous infusion every 3 weeks until disease recurrence or unmanageable toxicity, whichever occurs first
- Neoadjuvant treatment: administer PHESGO by subcutaneous injection every 3 weeks and chemotherapy by intravenous infusion preoperatively for 3 to 6 cycles or until disease recurrence or unmanageable toxicity, whichever occurs first, as a part of a complete regimen for early breast cancer
- Adjuvant treatment: administer PHESGO by subcutaneous injection every 3 weeks and chemotherapy by intravenous infusion postoperatively for a total of 1 year (up to 18 cycles) or until disease recurrence or unmanageable toxicity, whichever occurs first, as a part of a complete regimen for early breast cancer
PHESGO is a fixed-dose, subcutaneous combination of pertuzumab, trastuzumab and hyaluronidase in a single vial. The following video will review key points on how to properly store, prepare, and administer PHESGO.
On screen: Image of vial used for illustrative purposes only.
Let’s start with the product itself.
PHESGO is a fixed-dose combination, which means that all patients receive the same dose, regardless of their weight. PHESGO has different dosage and administration instructions than IV PERJETA + trastuzumab, and subcutaneous trastuzumab when administered alone. Do not substitute PHESGO for or with PERJETA, trastuzumab, ado-trastuzumab emtansine, or fam-trastuzumab deruxtecan.
PHESGO comes in two formulations:
The first formulation is a loading dose of 15 milliliters. This ready-to-use vial contains 1,200 milligrams of pertuzumab, 600 milligrams of trastuzumab, and 30,000 units of hyaluronidase.
The second formulation is a maintenance dose of 10 milliliters. This ready-to-use vial contains 600 milligrams of pertuzumab, 600 milligrams of trastuzumab, and 20,000 units of hyaluronidase.
PHESGO is supplied in sterile, preservative-free, single-dose vials for subcutaneous injection. Store PHESGO vials in the refrigerator at 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit) in the original carton to protect from light, until time of use. Do not freeze or shake the vials.
PREPARING THE PATIENT
There are a couple of points that can help a patient to prepare for the injection.
Consider asking the patient to wear loose clothing that will make it easy to access the thigh area. A skirt or loose shorts may be an option.
PREPARING THE INJECTION
Now it’s time to prepare the solution for the injection. Please follow your local or institutional guidelines for preparation.
When preparing for administering PHESGO, use the appropriate personal protective equipment, according to your local facility standards.
To prevent medication errors, it is important to check the vial labels to ensure the drug being prepared and administered is PHESGO.
Select the right dose, and check the expiration date. Inspect the vial for particulate matter and discoloration, whenever solution and container permit. PHESGO is clear to opalescent, and colorless to slightly brownish. Do not use if particulates or discoloration are present.
Both the initial and maintenance doses are ready to use for subcutaneous injection, and should not be diluted.
Start by attaching a transfer needle to the syringe. Remove and discard the vial cap and wipe the vial stopper with an alcohol swab. Allow the stopper to dry naturally, and then, holding the syringe by the barrel, insert the transfer needle into the center of the vial.
Now, invert the vial and slowly pull back the plunger until you’ve withdrawn the contents of the vial. Discard any unused portion remaining in the vial.
Once the contents are withdrawn from the vial, remove the needle from the vial. Then remove the transfer needle from the syringe.
Label the syringe with the included peel-off sticker.
If the solution will not be injected right away, replace the transfer needle with a syringe closing cap. Do not attach a hypodermic needle until the time of administration to avoid needle clogging.
After filling the syringe, PHESGO can be stored in the refrigerator for up to 24 hours, and at room temperature for up to 4 hours.
On screen:
- The syringe may be stored for up to 24 hours in the refrigerator (2°-8° C or 36°-46° F)
- A maximum of 4 hours at room temperature (20°-25° C or 68°-77° F)
- Avoid unnecessary storage
The solution should be administered at room temperature, so remove it from the fridge enough time in advance for it to warm up.
At the time of administration, detach the transfer needle or syringe stopper and discard, replacing it with a sterile injection needle.
The suitable injection needle for this solution is between 25 and 27 gauge and between 3/8 of an inch and 5/8 of an inch long.
PHESGO is now ready for injection.
ADMINISTERING THE INJECTION
PHESGO should always be administered by a healthcare professional.
Ask the patient to sit back in a reclining chair or bed and to make the thigh area accessible. Be sure to arrange your chair at the right level so that your feet are flat on the floor and you are able sit up straight without twisting, bending, or reaching to administer the injection. You will be in this position for approximately 5 to 8 minutes, so be sure you are comfortable and in a position that you can maintain.
The injection site should be alternated between the left and right thigh only. It is never administered in the abdomen or intravenously. Do not split the dose between two syringes or between two sites of administration.
Each new injection should be given at least 1 inch, or 2.5 cm, from the previous site.
Choose an area of healthy skin that is not red, bruised, tender, or hard. During treatment with PHESGO, other subcutaneous medications should preferably be injected at different sites.
On screen:
- Sanitize the area
To perform the injection, pinch the skin of the thigh with one hand to create a fold. This makes it easier to get the injection into the subcutaneous tissue and not into the muscle tissue.
The dose should be administered at a rate of no more than 2 milliliters per minute, so you can expect the loading dose to take approximately 8 minutes to administer, while the maintenance doses will take approximately 5 minutes.
The injection should be slowed or paused if the patient experiences a significant injection-related reaction. The injection should be discontinued immediately if the patient experiences a serious hypersensitivity reaction (for example, anaphylaxis).
On screen:
Evaluate and monitor patient until resolution of signs/symptoms
The preparation and administration time presents a good opportunity to talk with the patient, to get an overall sense of their well-being and to discuss any concerns they may be having.
Once the full dose has been administered, wait briefly before removing the needle to minimize any potential leak back.
After the loading dose, the patient should be observed for a minimum of 30 minutes, for signs of hypersensitivity symptoms or administration-related reactions. After the maintenance doses, the patient should be observed for a minimum of 15 minutes. Make sure that medication to treat reactions, as well as emergency equipment, is available for immediate use.
For full information on dosing considerations, dose modifications and monitoring, and complete administration information, please review the PHESGO full prescribing information.
On screen: Visit PHESGO.com for Full Prescribing Information
Thank you for taking the time to watch this video and for all the work that you do for patients.
On screen: To learn more about administering PHESGO, or to schedule an educational in-service contact us at[email protected].
Please continue watching for additional Important Safety Information.
Important Safety Information
Contraindications
PHESGO is contraindicated in patients with known hypersensitivity to pertuzumab, or trastuzumab, or hyaluronidase, or to any of its excipients.
Additional Important Safety Information
Cardiomyopathy and Cardiac Monitoring
- PHESGO administration can result in subclinical and clinical cardiac failure. The incidence and severity was highest in patients receiving PHESGO with anthracycline-containing chemotherapy regimens
- Discontinue PHESGO treatment in patients receiving adjuvant therapy and withhold PHESGO in patients with metastatic disease for clinically significant decrease in left ventricular function
- Evaluate cardiac function prior to and during treatment. For adjuvant therapy, also evaluate cardiac function after completion of PHESGO
- Monitor frequently for decreased left ventricular function during and after PHESGO treatment. Monitor more frequently if PHESGO is withheld for significant left ventricular cardiac dysfunction
Embryo-Fetal Toxicity
- PHESGO can cause fetal harm when administered to a pregnant woman
- Verify the pregnancy status of females of reproductive potential prior to the initiation of PHESGO. Advise pregnant women and females of reproductive potential that exposure to PHESGO during pregnancy or within 7 months prior to conception can result in fetal harm. Advise females of reproductive potential to use effective contraception during treatment and for 7 months following the last dose of PHESGO
- There is a pregnancy pharmacovigilance program for PHESGO. If PHESGO is administered during pregnancy, or if a patient becomes pregnant while receiving PHESGO or within 7 months following the last dose of PHESGO, health care providers and patients should immediately report PHESGO exposure to Genentech at 1-888-835-2555
Pulmonary Toxicity
- PHESGO can cause serious and fatal pulmonary toxicity. These adverse reactions have been reported with intravenous trastuzumab
- Pulmonary toxicity includes dyspnea, interstitial pneumonitis, pulmonary infiltrates, pleural effusions, non-cardiogenic pulmonary edema, pulmonary insufficiency and hypoxia, acute respiratory distress syndrome, and pulmonary fibrosis. Patients with symptomatic intrinsic lung disease or with extensive tumor involvement of the lungs, resulting in dyspnea at rest, appear to have more severe toxicity
Exacerbation of Chemotherapy-Induced Neutropenia
PHESGO may exacerbate chemotherapy-induced neutropenia. In randomized controlled clinical trials with intravenous trastuzumab, Grade 3-4 neutropenia and febrile neutropenia were higher in patients receiving trastuzumab in combination with myelosuppressive chemotherapy as compared to those who received chemotherapy alone
Hypersensitivity and Administration-Related Reactions
- Severe administration-related reactions (ARRs), including hypersensitivity, anaphylaxis, and events with fatal outcomes, have been associated with intravenous pertuzumab and trastuzumab. Patients experiencing dyspnea at rest due to complications of advanced malignancy and comorbidities may be at increased risk of a severe or of a fatal ARR
- In the FeDeriCa study, the incidence of hypersensitivity was 1.2% in the PHESGO arm. ARRs occurred in 21% of patients who received PHESGO. In the PHESGO arm, the most common administration-related reactions were injection site reaction (15%) and injection site pain (2%)
- Closely monitor patients during and for 30 minutes after the injection of initial dose and during and for 15 minutes following subsequent injections of maintenance dose of PHESGO. If a significant injection-related reaction occurs, slow down or pause the injection and administer appropriate medical therapies. Evaluate and carefully monitor patients until complete resolution of signs and symptoms
- Permanently discontinue treatment with PHESGO in patients who experience anaphylaxis or severe injection-related reactions. Medications to treat such reactions, as well as emergency equipment, should be available for immediate use. For patients experiencing reversible Grade 1 or 2 hypersensitivity reactions, consider pre-medication with an analgesic, antipyretic, or an antihistamine prior to readministration of PHESGO
Most Common Adverse Reactions
Early Breast Cancer
The most common adverse reactions (>30%) with PHESGO were alopecia, nausea, diarrhea, anemia, and asthenia.
Metastatic Breast Cancer (based on IV pertuzumab)
The most common adverse reactions (>30%) with pertuzumab in combination with trastuzumab and docetaxel were diarrhea, alopecia, neutropenia, nausea, fatigue, rash, and peripheral neuropathy.
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.
Please see full Prescribing Information for additional Important Safety Information, including BOXED WARNINGS.
Thank you.
Administration instructions
Important: PHESGO has different dosage and administration instructions than IV pertuzumab, IV trastuzumab, and subcutaneous trastuzumab when administered alone. Do not substitute PHESGO for or with PERJETA® (pertuzumab), trastuzumab, ado-trastuzumab emtansine, or fam-trastuzumab deruxtecan.1
PHESGO should be administered every 3 weeks1,2
Loading (initial) dose
1200 mg pertuzumab, 600 mg trastuzumab, 30,000 units hyaluronidase per 15 mL supplied in a single-dose, ready-to-use vial
Administer subcutaneously over approximately 8 minutes at a rate of no more than 2 mL/min
Observe for hypersensitivity or administration-related reactions:
minimum of 30 minutes*
NDC: 50242-245-01
Maintenance dose
600 mg pertuzumab, 600 mg trastuzumab, 20,000 units hyaluronidase per 10 mL supplied in a single-dose, ready-to-use vial
Administer subcutaneously over approximately 5 minutes at a rate of no more than 2 mL/min
Observe for hypersensitivity or administration-related reactions:
minimum of 15 minutes*
NDC: 50242-260-01
*Medications to treat such reactions, as well as emergency equipment, should be available for immediate use.
PHESGO must always be administered by a healthcare professional.
PHESGO is for subcutaneous use ONLY in the thigh. Do NOT administer intravenously.
- Do not split the dose between 2 syringes or between 2 sites of administration
- Injection site should be alternated between the left and right thigh only
- New injections should be given at least 1 inch from the previous site on healthy skin and never into areas where the skin is red, bruised, tender, or hard
- During the treatment course with PHESGO, other subcutaneous medications should preferably be injected at different sites
Patients currently receiving IV PERJETA + trastuzumab can be transitioned to PHESGO if eligible.1
Additional dosing considerations and dose modifications
<6 weeks since last dose of IV PERJETA + trastuzumab
START PHESGO with maintenance dose
≥6 weeks since last dose of IV PERJETA + trastuzumab
START PHESGO with loading dose
- In patients receiving IV PERJETA + trastuzumab with <6 weeks since their last dose, administer PHESGO as a maintenance dose of 600 mg, 600 mg, 20,000 units/10 mL and every 3 weeks for subsequent administrations
- In patients receiving IV PERJETA + trastuzumab with ≥6 weeks since their last dose, administer PHESGO as an initial dose of 1,200 mg, 600 mg, 30,000 units/15 mL, followed by a maintenance dose of 600 mg, 600 mg, 20,000 units/10 mL every 3 weeks for subsequent administrations
- In the PHranceSCa trial, patients were monitored for 30 minutes after their first dose of PHESGO, regardless of whether a loading dose was required. Medications to treat such reactions, as well as emergency equipment, should be available for immediate use
Assess left ventricular ejection fraction (LVEF) prior to initiation of PHESGO and at regular intervals during treatment.
| Pre-treatment LVEF: | Withhold PHESGO for at least 3 weeks for an LVEF decrease to: | Resume PHESGO after 3 weeks if LVEF has recovered to: | |
| Early Breast Cancer (EBC) | ≥55%† | <50% with a fall of ≥10%-points below pre-treatment value | EITHER ≥50% OR <10%-points below pre-treatment value |
| Metastatic Breast Cancer (MBC) | ≥50% | EITHER <40% OR 40%-45% with a fall of ≥10%-points below pre-treatment value | EITHER >45% OR 40%-45% with a fall of <10%-points below pre-treatment value |
‡For patients receiving anthracycline-based chemotherapy, a LVEF of ≥50% is required after completion of anthracyclines, before starting PHESGO.
Monitor LVEF prior to initiation and then every ~12 weeks in MBC and EBC (once during neoadjuvant therapy).
If after a repeat assessment within approximately 3 weeks, the LVEF has not improved, has declined further, and/or the patient is symptomatic, permanently discontinue PHESGO.
PHESGO could save time for your patients and practice1
Most major insurance plans provide coverage for PHESGO*3
*Data current as of May 2024. Insurer policies may vary and are subject to change.
Learn More About Dosing & Administration
Information about how to properly store, prepare, and administer PHESGO, including useful graphics and helpful tips.
See which treatment patients preferred*
*Based on the PHranceSCa trial.1
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PHESGO Prescribing Information. Genentech, Inc. 2020.
PHESGO Prescribing Information. Genentech, Inc. 2020.
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Data on file. Genentech, Inc.
Data on file. Genentech, Inc.
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Data on file. Genentech, Inc. MMIT Analysis. HLI Lives Database.
Data on file. Genentech, Inc. MMIT Analysis. HLI Lives Database.
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