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Systemic Anti-Cancer Therapy Regimen Library

Home > BR Metastatic - capecitabine 750 and neratinib

BR Metastatic - capecitabine 750 and neratinib

Treatment Overview

Cycle 1 (and all further cycles) - 21 days

Cycle length:
21

Cycle details

Cycle 1 (and all further cycles) - 21 days

Medication Dose Route Days Max Duration
doxycycline * 100 mg Once daily oral administration 0
hydrocortisone * 1 % Once daily topical administration 0
cetostearyl alcohol + paraffin liquid + paraffin soft white 50 g Once daily topical administration 0
avobenzone + homosalate + octisalate + octocrilene + oxybenzone 50 g topical administration 0
neratinib * 240 mg Once daily oral administration 1 to 21
capecitabine * 750 mg/m² Twice daily oral administration 1 to 14
loperamide 2 mg oral administration 1

Full details

Cycle 1 (and all further cycles) - 21 days

Day: 0

Medication Dose Route Max duration Details
doxycycline * 100 mg Once daily oral administration
Instructions:
  • To prevent rash.
  • Commence taking the day before (SACT medicine) and continue for 6 weeks or as per institutional policy. If no rash develops after 6 weeks, consider stopping.
  • Take each dose with food and a large glass of water. Swallow whole, do not crush or chew. Remain sitting upright or standing for at least 30 minutes afterwards. Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
hydrocortisone * 1 % Once daily topical administration
Instructions:
  • To prevent rash.
  • Apply to the face, hands, feet, neck, back and chest at bedtime or as directed by your oncologist.
  • If no rash develops after 6 weeks, consider stopping.
cetostearyl alcohol + paraffin liquid + paraffin soft white 50 g Once daily topical administration
Instructions:
  • Apply as a moisturiser to the face, hands, feet, neck, back and chest each morning or as directed by your oncologist.
  • Whilst this is a subsidised preparation, other moisturisers may also be suitable.
  • Quantity is approximate only, prescriber discretion required.
avobenzone + homosalate + octisalate + octocrilene + oxybenzone 50 g topical administration
Instructions:
  • SPF 50+ Sunscreen—apply to skin 30 minutes before going outdoors as directed by your oncologist.
  • Certified condition for subsidy. Whilst this is the subsidised preparation, alternative SPF 50+ sunscreen preparations may also be suitable.
  • Quantity is approximate only, prescriber discretion required.

Day: 1

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
loperamide 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) at onset of loose bowel motions and a further ONE capsule (=2 mg) for every loose bowel motion (maximum of EIGHT capsules in 24 hours), or use as directed by oncologist or haematologist.

Day: 2

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 3

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 4

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 5

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 6

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 7

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 8

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 9

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 10

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 11

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 12

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 13

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 14

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 15

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.

Day: 16

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.

Day: 17

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.

Day: 18

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.

Day: 19

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.

Day: 20

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.

Day: 21

Medication Dose Route Max duration Details
neratinib * 240 mg Once daily oral administration
Instructions:
Take each dose with food, preferably in the morning. Swallow whole with a glass of water, do not crush or chew. Avoid antacids 3 hours before or after taking this medicine. Avoid foods containing grapefruit, starfruit or Seville oranges during treatment.

Supportive Care Factors

Factor Value
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Minimal to low

Emetogenicity: MINIMAL to LOW—Antiemetics may be required with continuous dosing of oral anti-cancer medicines with MINIMAL to LOW emetic risk; an individualised approach is appropriate.

References

Saura C, Matito J, Oliveira M, Wildiers H, Brufksy AM, Waters SH, Hurvitz SA, Moy B, Kim SB, Gradishar WJ, Queiroz GS, Cronemberger E, Wallweber GJ, Bebchuk J, Keyvanjah K, Lalani AS, Bryce R, Vivancos A, Eli LD, Delaloge S. Biomarker Analysis of the Phase III NALA Study of Neratinib + Capecitabine versus Lapatinib + Capecitabine in Patients with Previously Treated Metastatic Breast Cancer. Clin Cancer Res. 2021 Nov 1;27(21):5818-5827. doi: 10.1158/1078-0432.CCR-21-1584. Epub 2021 Aug 11. , PMID: 34380637

Specialised Therapeutics Limited. Nerlynx New Zealand Data Sheet. 17 February 2022. https://www.medsafe.govt.nz/profs/Datasheet/n/nerlynxtab.pdf (Accessed 15 September 2023).

Viatris Ltd. Capecitabine Viatris New Zealand Data Sheet. 14 February 2023. https://www.medsafe.govt.nz/profs/datasheet/c/CapecitabineViatristab.pdf (Accessed 15 September 2023).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.