Neratinib as adjuvant therapy in patients with HER2 positive breast cancer: expert opinion

Future Oncol. 2023 Aug;19(24):1695-1708. doi: 10.2217/fon-2023-0361. Epub 2023 Aug 22.


Neratinib is a tyrosine kinase receptor inhibitor used in the extended adjuvant therapy of early-stage breast cancer. After adjuvant trastuzumab therapy, neratinib reduces the risk of recurrence and, if taken within 1 year from trastuzumab, significantly improves the invasive disease-free survival of patients with early-stage human epidermal growth factor receptor-2 positive (HER2+) breast cancer with no increased risk of long-term toxicity. Diarrhea, the most common adverse event associated with neratinib use, deters some clinicians from prescribing this drug. However, neratinib-related toxicity is predictable, short-lived, mostly limited to the first month of treatment and can be managed with dose-escalation and prophylactic strategies. Thus, close surveillance and prompt management, relying on supportive care and administration schedule modification, allows discontinuation of treatment to be avoided.

Keywords: HER2+; diarrhoea; disease-free survival; early-stage breast cancer; extended adjuvant therapy; neratinib; toxicity; trastuzumab; tyrosine kinase receptor inhibitors.

Publication types

  • Review

MeSH terms

  • Breast Neoplasms* / drug therapy
  • Combined Modality Therapy
  • Expert Testimony
  • Female
  • Humans
  • Protein Kinase Inhibitors / adverse effects
  • Trastuzumab / adverse effects


  • neratinib
  • Trastuzumab
  • Protein Kinase Inhibitors