Dr. Dawar on Challenges With Neratinib in Metastatic HER2+ Breast Cancer

Richa Dawar, MD, breast and thoracic oncologist, University of Miami Health System, discusses challenges with the use of neratinib (Nerlynx) in patients with metastatic HER2-positive breast cancer.

In February 2020, the combination of neratinib and capecitabine received regulatory approval for the treatment of patients with advanced or metastatic HER2-positive breast cancer who have received ≥2 prior anti—HER2-based regimens in the metastatic setting.

However, neratinib can be challenging for patients to tolerate due to significant diarrhea, says Dawar. Other adverse events associated with neratinib such as nausea and fatigue are typically manageable. However, diarrhea can impact a patient’s quality of life and lead to dehydration.

Patients with brain metastases may require treatment that crosses the blood-brain barrier. Therefore, neratinib may be necessary despite these toxicities, says Dawar. Starting patients on a low dose of the combination with antidiarrheal agents can help reduce the rate of diarrhea. Additionally, giving weekly intravenous fluids or switching to other antidiarrheal medications such as colestipol (Colestid) may help, concludes Dawar.