New Zealand Formulary
Menu Close Menu

Fewer cancers.
Better survival.
Equity for all.

Systemic Anti-Cancer Therapy Regimen Library

Home > BR Adjuvant - neratinib

BR Adjuvant - neratinib

Treatment Overview

Cycles 1 to 12 - 28 days

Cycle length:
28

Cycle details

Cycles 1 to 12 - 28 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 28
loperamide * 2 mg oral administration 1 to 28

Full details

Cycles 1 to 12 - 28 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 neratinib 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:
Apply to the face, hands, feet, neck, back and chest at bedtime or as directed by your oncologist to prevent rash. 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. Quantity is approximate only, prescriber discretion required. Whilst this is a subsidised preparation, other moisturisers may also be suitable.
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. Quantity is approximate only, prescriber discretion required. Whilst this is the subsidised preparation, alternative SPF 50+ sunscreen preparations may also be suitable.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

Day: 22

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

Day: 23

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

Day: 24

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

Day: 25

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

Day: 26

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

Day: 27

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

Day: 28

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.
loperamide * 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) THREE times daily on days 1 to 14, then take TWO capsules (=4 mg) TWICE daily on days 15 to 56. Thereafter, take TWO capsules (=4mg) as required titrating to 1-2 bowel movements per day, or as directed.

Supportive Care Factors

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

References

1. Chan, A., S. Delaloge, F. A. Holmes, et al. 2016. “Neratinib after trastuzumab-based adjuvant therapy in patients with HER2-positive breast cancer (ExteNET): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.” Lancet Oncol 17(3):367-377., PMID: 26874901

2. Martin, M., F. A. Holmes, B. Ejlertsen, et al. 2017. "Neratinib after trastuzumab-based adjuvant therapy in HER2-positive breast cancer (ExteNET): 5-year analysis of a randomised, double-blind, placebo-controlled, phase 3 trial." Lancet Oncol 18(12):1688-1700, PMID: 29146401

3. Specialised Therapeutics Limited. Nerlynx New Zealand Data Sheet. 26 June 2020. https://www.medsafe.govt.nz/profs/Datasheet/n/nerlynxtab.pdf (Accessed 11 December 2020).

4. Hofheinz RD, Deplanque G, Komatsu Y, et al. Recommendations for the Prophylactic Management of Skin Reactions Induced by Epidermal Growth Factor Receptor Inhibitors in Patients With Solid Tumors. Oncologist. 2016;21(12):1483-1491. , PMID: 27449521

5. Lacouture ME, Anadkat MJ, Bensadoun RJ, Bryce J, Chan A, Epstein JB, Eaby-Sandy B, Murphy BA; MASCC Skin Toxicity Study Group. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011 Aug;19(8):1079-95. Epub 2011 Jun 1. , PMID: 21630130

6. Deplanque, Gaël, et al. "Doxycycline for prevention of erlotinib-induced rash in patients with non-small-cell lung cancer (NSCLC) after failure of first-line chemotherapy: A randomized, open-label trial." Journal of the American Academy of Dermatology 74.6 (2016): 1077-1085., PMID: 26946985

7. Dika, Emi, and Annalisa Patrizi. "Prevention of erlotinib‐induced folliculitis with doxycycline." Dermatologic therapy 30.1 (2017): e12419., PMID: 27592506

* 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.