THP: docetaxel or paclitaxel, trastuzumab, and pertuzumab

THP (docetaxel or paclitaxel, trastuzumab, and pertuzumab) is a chemotherapy regimen used to treat all stages of HER2-positive breast cancer. It includes these medicines:

• Either docetaxel (Taxotere), paclitaxel (Taxol), or nab-paclitaxel (Abraxane), types of chemotherapy called taxanes
• Trastuzumab (Herceptin) – a type of targeted therapy called a monoclonal antibody
• Pertuzumab (Perjeta) – a type of monoclonal antibody

How THP works

Docetaxel, paclitaxel, and nab-paclitaxel work by damaging the structure or the “skeleton” that supports cancer cells. This stops the cancer cells from growing and dividing.

Trastuzumab attaches to HER2 proteins on the surface of HER2-positive cancer cells and blocks the signals that cause cancer cells to multiply. After attaching to cancer cells, it can also alert the immune system to kill them.

Pertuzumab also attaches to HER2 proteins on the surface of HER2-positive cancer cells and blocks the signals that cause cancer cells to multiply. It attaches to the HER2 protein in a different place than trastuzumab, so the two medicines work together well. After attaching to cancer cells, it can also alert the immune system to kill them.

Who gets THP

THP can be given to people diagnosed with early-stage or metastatic HER2-positive breast cancer.

You and your doctor will discuss the best chemotherapy treatment for your situation.

How THP is given

THP is given by vein.

In early-stage breast cancer

In early-stage breast cancer, THP can be given before (neoadjuvant) or sometimes after (adjuvant) surgery. 

When given as neoadjuvant treatment before surgery, THP is usually given four to six times, once every 3 weeks. If paclitaxel is the choice of taxane used in this regimen, it is given weekly and the trastuzumab and pertuzumab are given every 3 weeks.

After surgery, you will receive trastuzumab either weekly or once every 3 weeks for a total of a year. You may receive other chemotherapy as well.

THP can be given alone or as part of a combined treatment regimen. One example is giving THP before or after the targeted therapy trastuzumab deruxtecan (Enhertu).

In metastatic breast cancer

For metastatic breast cancer, THP is usually given once every 3 weeks. It may be given as long as it controls the disease and side effects do not disrupt your quality of life.

If your doctor recommends you stop docetaxel, paclitaxel, or nab-paclitaxel due to side effects, you may still be able to continue treatment with pertuzumab and trastuzumab.

Side effects and things to remember

Different medicines have different side effects. You may not have every side effect related to each medicine of the combination therapy.

Side effects of THP may include:

• Hair loss
• Fatigue
• Diarrhea
• Decrease of white blood cells, red blood cells, and platelets
• Nausea
• Mouth sores
• Nail and skin changes
• Neuropathy (numbness and tingling in the hands or feet)
• Joint or muscle pain

Heart problems are a rare but serious side effect of trastuzumab. These include congestive heart failure, when the heart muscle weakens and doesn’t pump blood well. Your doctor will check your heart before you start treatment and every several months during treatment. Be sure to tell your doctor if you have ever had heart problems.

Tell your doctor about any medicines you are taking, including vitamins, herbal supplements, and over-the counter-medicines, to make sure they will not interfere with your chemotherapy treatment.

Contact your doctor right away if you develop a fever or other symptoms of an infection such as a sore throat or chills.

Talk to your doctor, pharmacist, or nurse about all your side effects so that they can help you manage them. You can also visit our section on side effects for more information.