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Neratinib: Comprehensive Guide for HER2-Positive Cancer Treatment
Summary or Key Points
Neratinib is an oral medication used to treat certain types of cancer, including HER2-positive breast cancer. It works by blocking proteins that encourage cancer cell growth. Neratinib is often prescribed after treatments like surgery or chemotherapy to help reduce the risk of cancer returning. As with any medication, it may cause side effects, so it’s important to discuss any concerns with your healthcare provider.
Names of Medication
US Brand Name: Nerlynx
Generic Name: Neratinib
The generic name refers to the active ingredient in the medication and is listed in parentheses after the brand name.
Pharmacologic Category
Tyrosine Kinase Inhibitor (TKI)
HER2/EGFR Inhibitor
Dosing Information for Neratinib
Neratinib is used to treat various cancers in adults. The dosing schedule depends on the specific condition being treated. Always follow your doctor’s instructions and consult them before making any changes to your dose. If you need to speak with a healthcare provider, you can schedule a telemedicine appointment with us today.
Breast Cancer (HER2-Positive, Early-Stage)
Indication: Neratinib is used as extended adjuvant therapy following trastuzumab-based treatment.
Dosage: 240 mg (6 tablets) taken orally once daily with food for 1 year.
Metastatic Breast Cancer (HER2-Positive)
Indication: Neratinib is used in combination with capecitabine for HER2-positive metastatic breast cancer.
Dosage: 240 mg (6 tablets) taken orally once daily with food, in 21-day cycles, combined with capecitabine (750 mg/m² twice daily for 14 days of each 21-day cycle).
Locally Advanced Breast Cancer
Indication: Neratinib is used with other therapies to treat locally advanced HER2-positive breast cancer.
Dosage: 240 mg (6 tablets) taken orally once daily with food, typically for 1 year or as directed by your doctor.
Triple-Negative Breast Cancer (HER2-Low)
Indication: Neratinib may be used with other treatments for triple-negative breast cancer with low HER2 expression.
Dosage: 240 mg (6 tablets) taken orally once daily with food, as part of a treatment regimen determined by your healthcare provider.
Gastric Cancer
Indication: Neratinib is being studied for HER2-positive gastric cancer.
Dosage: The dosage may vary based on clinical trial protocols. Consult your doctor for specific dosing information.
Esophageal Cancer
Indication: Neratinib is being evaluated for HER2-positive esophageal cancer.
Dosage: The dosage may vary based on clinical trial protocols. Consult your doctor for specific dosing information.
Colorectal Cancer
Indication: Neratinib is being studied for HER2-positive colorectal cancer.
Dosage: The dosage may vary based on clinical trial protocols. Consult your doctor for specific dosing information.
Non-Small Cell Lung Cancer (NSCLC)
Indication: Neratinib is being studied for HER2-positive non-small cell lung cancer.
Dosage: The dosage may vary based on clinical trial protocols. Consult your doctor for specific dosing information.
Dosage Forms and Strengths
Tablets: 40 mg
Administration Instructions for Neratinib
Neratinib should be taken with food to help reduce the risk of side effects, particularly diarrhea. Swallow the tablets whole; do not crush, chew, or split them. It’s important to take Neratinib at the same time each day to maintain consistent levels of the medication in your body. If you miss a dose, take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take two doses at once.
Adverse Reactions and Side Effects of Neratinib
Like all medications, Neratinib can cause side effects. Some are more common, while others are rare but potentially serious. If you experience any side effects, contact your healthcare provider immediately. You can also schedule a telemedicine appointment with us to discuss your symptoms.
Common Side Effects
Diarrhea: This is the most common side effect. Your doctor may prescribe anti-diarrheal medication to help manage it.
Nausea: Feeling nauseous is common, especially during the first few weeks of treatment.
Fatigue: You may feel more tired than usual while taking Neratinib.
Abdominal Pain: Some patients experience discomfort or pain in the stomach area.
Less Common Side Effects
Rash: Skin irritation or rash can occur but is usually mild.
Decreased Appetite: Some patients may notice a reduced desire to eat.
Vomiting: While less common, vomiting can occur, especially if nausea is not well controlled.
Serious Side Effects
Liver Damage: In rare cases, Neratinib can cause liver problems. Symptoms may include yellowing of the skin or eyes, dark urine, and upper stomach pain. Contact your doctor immediately if you notice these symptoms.
Severe Diarrhea: In some cases, diarrhea can become severe and lead to dehydration. It’s important to stay hydrated and follow your doctor’s instructions on managing this side effect.
Contraindications for Neratinib
A contraindication is a specific situation where a medication should not be used because it may be harmful. Before starting any new medication, it’s important to know if you have any conditions that make taking it unsafe. Here are the contraindications for Neratinib:
Allergy to Neratinib or any of its ingredients: If you have had an allergic reaction to Neratinib or any of its components, you should not take this medication. Allergic reactions can range from mild symptoms like a rash to severe reactions such as difficulty breathing or anaphylaxis.
Severe liver disease: Neratinib is processed by the liver, and if you have severe liver disease, your body may not handle the medication properly, leading to increased side effects or toxicity.
If you have any of these conditions, it’s crucial to discuss them with your healthcare provider before starting Neratinib. Our telemedicine providers are available to help you assess whether Neratinib is right for you.
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Drug to Drug Interactions
Neratinib can interact with other medications, potentially affecting its effectiveness or increasing the risk of serious side effects. Below are some common medications that may interact with Neratinib:
Proton pump inhibitors (PPIs): Medications like omeprazole (Prilosec) or esomeprazole (Nexium) can reduce the absorption of Neratinib, making it less effective.
Strong CYP3A4 inhibitors: Drugs such as ketoconazole (Nizoral) or ritonavir (Norvir) can increase the levels of Neratinib in the body, which may heighten the risk of side effects.
Strong CYP3A4 inducers: Medications like rifampin (Rifadin) or carbamazepine (Tegretol) can lower Neratinib levels, reducing its effectiveness.
Antacids: Drugs like calcium carbonate (Tums) can interfere with Neratinib absorption if taken at the same time. It’s recommended to take antacids at least 3 hours before or after taking Neratinib.
Always inform your healthcare provider about all medications you are taking, including over-the-counter drugs, supplements, and herbal products. If you’re unsure about potential interactions, our telemedicine providers can review your medication list and help you make informed decisions.
Neratinib in Pregnancy
Is it Safe to Take Neratinib During Pregnancy?
Neratinib is not recommended during pregnancy. Animal studies have shown that it can harm the developing fetus, leading to birth defects or pregnancy loss. While data on its use in pregnant women is limited, it is advised to avoid Neratinib if you are pregnant or planning to become pregnant.
If you are of childbearing age and taking Neratinib, it is important to use effective contraception during treatment and for at least 1 month after your last dose. If you become pregnant while on Neratinib, contact your healthcare provider immediately to discuss your options.
Neratinib While Breastfeeding
Is it Safe to Take Neratinib While Breastfeeding?
Breastfeeding is not recommended while taking Neratinib. Although it is not known whether Neratinib passes into breast milk, the potential for serious side effects in a nursing infant suggests avoiding breastfeeding during treatment and for at least 1 month after the last dose.
If you are breastfeeding or planning to breastfeed, talk to your healthcare provider about alternative feeding options for your baby while on Neratinib. Our telemedicine providers can help you navigate these decisions and provide support.
Estimated Cost of Medication
The cost of a 30-day supply of Neratinib without insurance can vary. With a GoodRx coupon, the estimated cost is around $11,000 to $12,000 for a 30-day supply. Prices may differ depending on the pharmacy and location.
If cost is a concern, speak with your healthcare provider about financial assistance programs or alternative treatment options. Our telemedicine providers can guide you through these options.
Possible Alternatives to Neratinib
Depending on your cancer type and treatment goals, alternative medications or lifestyle changes may be considered. Always discuss alternatives with your healthcare provider before making any changes to your treatment plan. Here are some alternatives for different types of cancer:
- Breast cancer (HER2-positive): Other targeted therapies like trastuzumab (Herceptin) or pertuzumab (Perjeta) may be options. Chemotherapy, radiation, or surgery are also common treatments.
- Metastatic breast cancer: Depending on the subtype, treatments may include hormone therapy, chemotherapy, or other targeted therapies like lapatinib (Tykerb).
- Early-stage breast cancer: Surgery (lumpectomy or mastectomy) followed by radiation or chemotherapy may be recommended. Hormonal therapy may also be used for hormone receptor-positive cancers.
- Locally advanced breast cancer: A combination of surgery, radiation, chemotherapy, and targeted therapies may be used.
- Triple-negative breast cancer: Chemotherapy is the main treatment, but immunotherapy (e.g., pembrolizumab) may also be an option.
- Gastric cancer: Surgery, chemotherapy, and targeted therapies like trastuzumab (for HER2-positive cases) are common treatments.
- Esophageal cancer: Treatment may include surgery, radiation, chemotherapy, and targeted therapies such as trastuzumab for HER2-positive cancers.
- Colorectal cancer: Surgery, chemotherapy, radiation, and targeted therapies like cetuximab (Erbitux) may be considered.
- Non-small cell lung cancer: Depending on the stage, treatments may include surgery, chemotherapy, radiation, and targeted therapies like osimertinib (Tagrisso) for specific genetic mutations.
Consult with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to discuss these alternatives and help you make the best decision for your health.
Recent Updates on Neratinib Research
Recent studies on Neratinib focus on its use in combination with other therapies to improve outcomes for patients with HER2-positive breast cancer. For example, ongoing research is evaluating the effectiveness of Neratinib with capecitabine (Xeloda) for patients with metastatic HER2-positive breast cancer who have previously been treated with trastuzumab. Early results suggest this combination may help delay disease progression.
Researchers are also exploring Neratinib’s use in other cancers, such as HER2-positive gastric and colorectal cancers, though these studies are still in early stages.
As research continues, new treatment options and combinations may emerge. If you’re interested in learning more about the latest research or clinical trials involving Neratinib, our telemedicine providers can help you explore these options.
