通用名称：注射用曲妥珠单抗

　　英文名称：Trastuzumab Injection
　　

　　【成分】
　　本品主要成分为曲妥珠单抗。

　　【性状】
　　本药每瓶含浓缩曲妥珠单抗粉末440 mg，为白色至淡黄色冻干粉剂。

　　【药理作用】
　　赫赛汀是一种重组DNA衍生的人源化单克隆抗体，选择性地作用于人表皮生长因子受体-2(HER2)的细胞外部位。在原发性乳腺癌患者中观察到有25%-30%的患者HER2过度表达。研究表明，HER2过度表达的肿瘤患者较无过度表达的无病生存期短。赫赛汀?在体外及动物实验中均显示可抑制HER2过度表达的肿瘤细胞的增殖。另外，赫赛汀是抗体依赖的细胞介导的细胞毒反应(ADCC)的潜在介质。在体外研究中，赫赛汀介导的ADCC被证明在HER2过度表达的癌细胞中比HER2非过度表达的癌细胞中更优先产生。

　　【药代动力学】
　　药物清除 对转移性乳腺癌的研究表明，短时间静脉输入10，50，100，250和500mg曲妥珠单抗每周1次的药代动力学呈剂量依赖性。随剂量水平的提高，平均半衰期延长，清除率下降。在临床试验中，使用了曲妥珠单抗4mg/kg的首次负荷量和2mg/kg每周维持量，观察到其平均半衰期为5.8天（1-32天），在16-32周之间，曲妥珠单抗的血浆浓度达到稳定状态，平均谷浓度约75ug/mL。特殊临床情况下的药物动力学,病人特性（如年龄，血浆肌酐浓度）对曲妥珠单抗分布的影响也进行了评价。数据显示，曲妥珠单抗的体内分布在不同亚群病人中均无变化。

　　【适应症】
　　适用于治疗HER2过度表达的转移性乳腺癌。
　　a) 作为单一药物治疗已接受过1个或多个化疗方案的转移性.乳腺癌.
　　b) 与紫杉类药物合用治疗未接受过化疗的转移性乳腺癌.

　　【用法用量】
　　初次负荷剂量：建议赫赛汀初次负荷量为4mg/kg。90分钟内静脉输入。维持剂量：建议每周赫赛汀用量为2mg/kg。如初次负荷量可耐受，则此剂量可于30分钟内输完赫赛汀可一直用到疾病进展。根据国外市场调查资料显示：接受治疗的患者平均约连续使用24至26周。

　　【不良反应】
　　所有不良事件的数据均由临床试验得到，本药均按推荐剂量单药或与化疗药（蒽环类[阿霉素或表阿霉素]加环磷酰胺或紫杉醇）合用。单独使用赫赛汀,有HER2过度表达的转移癌患者，已对进行过1或多个方案化疗无效者单独使用本药。213例患者，下列不良反应发生率≥ (greater than or equal to) 5% ：整体 ：腹痛，意外损伤，乏力，背痛，胸痛，寒战，发热，感冒样症状，头痛，感染，颈痛，疼痛。心血管 ：血管扩张。消化 ：厌食，便秘，腹泻，消化不良，胃肠胀气，呕吐和恶心。代谢 ：周围水肿，水肿。肌肉骨骼 ：关节痛，肌肉疼痛。神经系统 ：焦虑，抑郁，眩晕，失眠，感觉异常，嗜睡。呼吸 ：哮喘，咳嗽增多，呼吸困难，鼻出血，肺部疾病，胸腔积液，咽炎，鼻炎，鼻窦炎。皮肤 ：瘙痒，皮疹。

　　【禁 忌】
　　对曲妥珠单抗或其它成分过敏的患者禁止使用。

　　【注意事项】
　　本药治疗必须在治疗癌症方面很有经验的内科医生的监测下开始进行。在使用本药治疗的患者中观察到有心脏功能减退的症状和体征，如呼吸困难，咳嗽增加，夜间阵发性呼吸困难，周围性水肿，S3奔马律或射血分数减低。与赫赛汀治疗相关的充血性心衰可能相当严重，并可引起致命性心衰、死亡、粘液栓子脑栓塞。特别在赫赛汀与蒽环类药（阿霉素或表阿霉素）和环磷酰胺合用治疗转移乳腺癌的患者中，观察到中至重度的心功能减退（纽约心脏学会（NYHA）分级的III/IV）。在治疗前就有心功能不全的患者需特别小心。选择使用本药治疗的患者应进行全面的基础心脏评价，包括病史，物理检查和以下一或多项检查：EKG，超声心动图，MUGA扫描。目前尚无数据显示有合适的评价方法可确定病人有发生心脏毒性危险。在本药治疗过程中，左室功能应经常评估。若患者出现临床显著的左室功能减退应考虑停用赫赛汀。监测并不能全部发现将发生心功能减退的患者。约2/3有心功能减退的患者因有症状被治疗，大多数治疗后症状好转。治疗通常包括利尿药，强心苷类药和/或血管紧张素转换酶抑制剂类药。绝大多数用本药治疗临床有效的有心脏症状和表现的患者继续每周使用赫赛汀，并未产生更多的临床心脏情况。在灭菌注射水中，苯乙醇作为防腐剂，它对新生儿和3岁以下的儿童有毒性。当本药用于已知对苯乙醇过敏的病人时，应用注射用水重新配制。

　　【孕妇及哺乳期妇女用药】
　　在发育早期（孕20-50天）和晚期（孕120-150天）均观察到曲妥珠单抗经胎盘传送入胎儿。鉴于动物生殖研究结果并不能预示人类的反应，赫赛汀应不用于孕期妇女，除非对孕妇的潜在好处远大于对胎儿的潜在危险。
　　哺乳期妇女 ：哺乳期cynomolgus猴子用25倍人每周维持量赫赛汀（2 mg/kg）进行研究，显示曲妥珠单抗可分泌到乳汁里。出生3月内，幼猴血中存在曲妥珠单抗对其生长发育无任何不利影响。

　　【儿童用药】
　　小于18岁患者使用本药的安全性和疗效尚未确立

通用名称：注射用曲妥珠单抗

　　英文名称：Trastuzumab Injection
　　

　　【成分】
　　本品主要成分为曲妥珠单抗。

　　【性状】
　　本药每瓶含浓缩曲妥珠单抗粉末440 mg，为白色至淡黄色冻干粉剂。

　　【药理作用】
　　赫赛汀是一种重组DNA衍生的人源化单克隆抗体，选择性地作用于人表皮生长因子受体-2(HER2)的细胞外部位。在原发性乳腺癌患者中观察到有25%-30%的患者HER2过度表达。研究表明，HER2过度表达的肿瘤患者较无过度表达的无病生存期短。赫赛汀?在体外及动物实验中均显示可抑制HER2过度表达的肿瘤细胞的增殖。另外，赫赛汀是抗体依赖的细胞介导的细胞毒反应(ADCC)的潜在介质。在体外研究中，赫赛汀介导的ADCC被证明在HER2过度表达的癌细胞中比HER2非过度表达的癌细胞中更优先产生。

　　【药代动力学】
　　药物清除 对转移性乳腺癌的研究表明，短时间静脉输入10，50，100，250和500mg曲妥珠单抗每周1次的药代动力学呈剂量依赖性。随剂量水平的提高，平均半衰期延长，清除率下降。在临床试验中，使用了曲妥珠单抗4mg/kg的首次负荷量和2mg/kg每周维持量，观察到其平均半衰期为5.8天（1-32天），在16-32周之间，曲妥珠单抗的血浆浓度达到稳定状态，平均谷浓度约75ug/mL。特殊临床情况下的药物动力学,病人特性（如年龄，血浆肌酐浓度）对曲妥珠单抗分布的影响也进行了评价。数据显示，曲妥珠单抗的体内分布在不同亚群病人中均无变化。

　　【适应症】
　　适用于治疗HER2过度表达的转移性乳腺癌。
　　a) 作为单一药物治疗已接受过1个或多个化疗方案的转移性.乳腺癌.
　　b) 与紫杉类药物合用治疗未接受过化疗的转移性乳腺癌.

　　【用法用量】
　　初次负荷剂量：建议赫赛汀初次负荷量为4mg/kg。90分钟内静脉输入。维持剂量：建议每周赫赛汀用量为2mg/kg。如初次负荷量可耐受，则此剂量可于30分钟内输完赫赛汀可一直用到疾病进展。根据国外市场调查资料显示：接受治疗的患者平均约连续使用24至26周。

　　【不良反应】
　　所有不良事件的数据均由临床试验得到，本药均按推荐剂量单药或与化疗药（蒽环类[阿霉素或表阿霉素]加环磷酰胺或紫杉醇）合用。单独使用赫赛汀,有HER2过度表达的转移癌患者，已对进行过1或多个方案化疗无效者单独使用本药。213例患者，下列不良反应发生率≥ (greater than or equal to) 5% ：整体 ：腹痛，意外损伤，乏力，背痛，胸痛，寒战，发热，感冒样症状，头痛，感染，颈痛，疼痛。心血管 ：血管扩张。消化 ：厌食，便秘，腹泻，消化不良，胃肠胀气，呕吐和恶心。代谢 ：周围水肿，水肿。肌肉骨骼 ：关节痛，肌肉疼痛。神经系统 ：焦虑，抑郁，眩晕，失眠，感觉异常，嗜睡。呼吸 ：哮喘，咳嗽增多，呼吸困难，鼻出血，肺部疾病，胸腔积液，咽炎，鼻炎，鼻窦炎。皮肤 ：瘙痒，皮疹。

　　【禁 忌】
　　对曲妥珠单抗或其它成分过敏的患者禁止使用。

　　【注意事项】
　　本药治疗必须在治疗癌症方面很有经验的内科医生的监测下开始进行。在使用本药治疗的患者中观察到有心脏功能减退的症状和体征，如呼吸困难，咳嗽增加，夜间阵发性呼吸困难，周围性水肿，S3奔马律或射血分数减低。与赫赛汀治疗相关的充血性心衰可能相当严重，并可引起致命性心衰、死亡、粘液栓子脑栓塞。特别在赫赛汀与蒽环类药（阿霉素或表阿霉素）和环磷酰胺合用治疗转移乳腺癌的患者中，观察到中至重度的心功能减退（纽约心脏学会（NYHA）分级的III/IV）。在治疗前就有心功能不全的患者需特别小心。选择使用本药治疗的患者应进行全面的基础心脏评价，包括病史，物理检查和以下一或多项检查：EKG，超声心动图，MUGA扫描。目前尚无数据显示有合适的评价方法可确定病人有发生心脏毒性危险。在本药治疗过程中，左室功能应经常评估。若患者出现临床显著的左室功能减退应考虑停用赫赛汀。监测并不能全部发现将发生心功能减退的患者。约2/3有心功能减退的患者因有症状被治疗，大多数治疗后症状好转。治疗通常包括利尿药，强心苷类药和/或血管紧张素转换酶抑制剂类药。绝大多数用本药治疗临床有效的有心脏症状和表现的患者继续每周使用赫赛汀，并未产生更多的临床心脏情况。在灭菌注射水中，苯乙醇作为防腐剂，它对新生儿和3岁以下的儿童有毒性。当本药用于已知对苯乙醇过敏的病人时，应用注射用水重新配制。

　　【孕妇及哺乳期妇女用药】
　　在发育早期（孕20-50天）和晚期（孕120-150天）均观察到曲妥珠单抗经胎盘传送入胎儿。鉴于动物生殖研究结果并不能预示人类的反应，赫赛汀应不用于孕期妇女，除非对孕妇的潜在好处远大于对胎儿的潜在危险。
　　哺乳期妇女 ：哺乳期cynomolgus猴子用25倍人每周维持量赫赛汀（2 mg/kg）进行研究，显示曲妥珠单抗可分泌到乳汁里。出生3月内，幼猴血中存在曲妥珠单抗对其生长发育无任何不利影响。

　　【儿童用药】
　　小于18岁患者使用本药的安全性和疗效尚未确立

Product details

Publication details

Contact address:

Pfizer Europe MA EEIG
Ramsgate Road
Sandwich
Kent CT13 9NJ
United Kingdom 

An overview of Trazimera and why it is authorised in the EU

Trazimera is a cancer medicine used to treat the following conditions:

· early breast cancer (when the cancer has spread within the breast or to the glands under the arm but not to other parts of the body) after surgery, chemotherapy (medicines to treat cancer), and radiotherapy (treatment with radiation) if applicable. It can also be used earlier in treatment, in combination with chemotherapy. For cancers that are locally advanced (including those that are inflammatory) or more than 2 cm wide, Trazimera is used before surgery in combination with chemotherapy and then again after surgery on its own;

· metastatic breast cancer (cancer that has spread to other parts of the body). It is used on its own when other treatments have not worked or are not suitable. It is also used in combination with other cancer medicines: with paclitaxel or docetaxel, or with another class of medicines called aromatase inhibitors;

· metastatic gastric (stomach) cancer, in combination with cisplatin and either capecitabine or fluorouracil (other cancer medicines).

Trazimera can only be used when the cancer ‘overexpresses HER2’: this means that the cancer produces a protein called HER2 in large quantities on the cancer cells. HER2 is overexpressed in about a quarter of breast cancers and a fifth of gastric cancers.

Trazimera is a ‘biosimilar medicine’. This means that Trazimera is highly similar to another biological medicine (the ‘reference medicine’) that is already authorised in the EU. The reference medicine for Trazimera is Herceptin.

Trazimera contains the active substance trastuzumab.

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How is Trazimera used?

Trazimera can only be obtained with a prescription and treatment should be started by a doctor who has experience in the use of cancer medicines.

It is given by infusion (drip) into a vein over 90 minutes every week or every 3 weeks for breast cancer, and every 3 weeks for gastric cancer. For early breast cancer, treatment is given for a year or until the disease comes back, and for metastatic breast or gastric cancer, treatment is continued for as long as it remains effective. The dose depends on the patient’s body weight, on the condition being treated and on whether Trazimera is given every week or every 3 weeks.

The infusion may cause allergic reactions, so the patient should be monitored during and after the infusion. Patients who do not have significant reactions to the first 90minute infusion can receive subsequent infusions over 30 minutes.

For more information about using Trazimera, see the package leaflet or contact a doctor or pharmacist.

How does Trazimera work?

The active substance in Trazimera, trastuzumab, is a monoclonal antibody (a type of protein) designed to recognise and attach to the HER2 protein. By attaching to HER2, trastuzumab activates cells of the immune system, which then kill the tumour cells. Trastuzumab also stops HER2 from producing signals that cause the tumour cells to grow.

What benefits of Trazimera have been shown in studies?

Laboratory studies comparing Trazimera with Herceptin have shown that the active substance in Trazimera is highly similar to that in Herceptin in terms of structure, purity and biological activity. Studies have also shown that giving Trazimera produces similar levels of the active substance in the body to giving Herceptin.

In addition, a main study involving 707 patients with metastatic breast cancer that overexpressed HER2 showed that Trazimera was as effective in treating the condition as Herceptin. In this study, 63% of patients given Trazimera had a complete or partial response to treatment compared with 67% of those given Herceptin.

Because Trazimera is a biosimilar medicine, the studies on effectiveness and safety of trastuzumab carried out with Herceptin do not all need to be repeated for Trazimera.

What are the risks associated with Trazimera?

The most common or serious side effects with Trazimera are heart problems, reactions related to the Trazimera infusion, reduced levels of blood cells (especially white blood cells), infections and lung problems.

Trazimera can cause cardiotoxicity (harm to the heart), including heart failure (when the heart does not work as well as it should). Care should be taken if it is given to patients who already have heart problems or high blood pressure, and all patients need to be monitored during and after treatment to check their heart.

Trazimera must not be used in people who are hypersensitive (allergic) to trastuzumab, mouse proteins or to any of the other ingredients. It must not be used in patients whose advanced cancer causes serious breathing problems even when resting, or who need oxygen therapy.

For the full list of side effects and restrictions, see the package leaflet.

Why is Trazimera authorised in the EU?

The European Medicines Agency decided that, in accordance with EU requirements for biosimilar medicines, Trazimera has been shown overall to have a comparable quality, safety and effectiveness to Herceptin. Therefore, the Agency’s view was that, as for Herceptin, the benefit of Trazimera outweighs the identified risk and it can be authorised.

What measures are being taken to ensure the safe and effective use of Trazimera?

Recommendations and precautions to be followed by healthcare professionals and patients for the safe and effective use of Trazimera have been included in the summary of product characteristics and the package leaflet.

As for all medicines, data on the use of Trazimera are continuously monitored. Side effects reported with Trazimera are carefully evaluated and any necessary action taken to protect patients.

Other information about Trazimera

Trazimera received a marketing authorisation valid throughout the EU on 26.07.2018.