Enhertu
Enhertu (fam-trastuzumab deruxtecan-nxki) is FDA approved to treat adults with cancers that have a tumor marker protein called HER2. These include breast cancer, non-small cell lung cancer (NSCLC), stomach cancer, esophageal cancer, and other solid tumors. Enhertu is a targeted cancer treatment called an antibody-drug conjugate (ADC). It's usually used when certain past treatments haven't worked well. The dose is given as an infusion through the vein, or IV, every 3 weeks. Common side effects include nausea, tiredness, and hair loss.
What is Enhertu?
What is Enhertu used for?
- Advanced or metastatic HER2-positive or HER2-low breast cancer
- Advanced or metastatic HR-positive, HER2-low or HER2-ultralow breast cancer
- Advanced or metastatic non-small cell lung cancer with HER2 mutations
- Advanced or metastatic HER2-positive stomach cancer
- Advanced or metastatic HER2-positive esophageal cancer
- Advanced or metastatic HER2-positive solid tumors
How Enhertu works
Enhertu is a type of targeted cancer medication called an antibody-drug conjugate (ADC). It's made up of a few components that work together to find and destroy cancer or tumor cells in the body.
The first component of Enhertu works as a monoclonal antibody. It finds HER2, a protein found on cancer cells. The antibody helps Enhertu get to the cancer cells that have the HER2 protein on them.
When Enhertu reaches and enters the cancer cell, the chemotherapy part of the medication starts to work. It acts as a topoisomerase inhibitor, damaging the cancer cell's DNA and killing it. This helps stop the cancer from growing or spreading.
Drug facts
More on Enhertu essentials
Side effects of Enhertu
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Low white blood cell count (up to 73%)
- Nausea (72%)
- Lower hemoglobin levels (67%)
- Feeling very tired (55%)
- Lower platelet levels (48%)
- Higher liver enzyme levels (up to 46%)
- Vomiting (38%)
- Hair loss (37%)
- Constipation (32%)
- Low potassium levels (32%)
- Low appetite (31%)
- Diarrhea (30%)
- Muscle, bone, or joint pain (24%)
Less Common Side Effects
- Stomach pain
- Indigestion
- Mouth sores
- Weight loss
- Headache
- Dizziness
- Nosebleed
- Cough
- Shortness of breath
- Respiratory infection
- Numbness or tingling in the arms or legs
- Fever
- Rash
- Infusion reactions (e.g., chills, nausea, headache, flushing)
Note: Side effects were from people with breast cancer, NSCLC, or solid tumors. Side effects might differ for those with stomach or esophageal cancer.
Enhertu serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Lung problems: cough, having trouble catching your breath, wheezing, chest tightness, fever
- Low white blood cell count and infection: fever, chills, feeling generally unwell
- Lower heart function: cough, having trouble catching your breath, feeling tired or dizzy, swelling of your ankles or legs, sudden weight gain, irregular heartbeat
The following Enhertu side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dry cough, shortness of breath or trouble breathing
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Heart failure—shortness of breath, swelling of the ankles, feet, or hands, sudden weight gain, unusual weakness or fatigue
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Enhertu
Pros
- Given just by itself (not taken with other cancer treatments)
- Given once every 3 weeks
- A possible option after previous treatments haven’t worked
Cons
- Given as an infusion through the vein (IV)
- Can often cause nausea, vomiting, and hair loss
- Might raise the risk of infections
Pharmacist tips for Enhertu
- Keep track of when your Enhertu infusions are. It's given once every 3 weeks, usually on day 1 of every 21-day treatment cycle. Write the dates and times of your infusion appointments in your calendar to help you remember.
- Your first Enhertu infusion will take about an hour and a half. This helps your care team see how well you can tolerate the infusion. If it goes smoothly, the rest of your infusions can be faster and take about 30 minutes.
- It’s a good idea to budget a few hours for each Enhertu infusion appointment. Also bring something to do to pass the time, like a book or an electronic device. Besides the infusion, there might be other things that take some time when you’re at the infusion center or clinic. This can include settling in and getting lab draws.
- Enhertu often causes nausea and vomiting. To help prevent this, your care team will give you medication before each infusion. Your oncologist might also prescribe anti-nausea medications to take at home if you need it.
- Get heart scans done when your oncologist tells you to while taking Enhertu. Your care team might need to check for changes in how your is working or signs of heart failure. Tell them right away if you have shortness of breath, cough, swelling in your ankles or legs, sudden weight gain, or dizziness. These can be signs of heart failure.
- If you or your partner can get pregnant, use effective birth control during Enhertu treatment. Keep using birth control for 7 months after your last dose if you’re a woman, and for 4 months after your last dose if you’re a man. Enhertu can harm an unborn baby if given during pregnancy.
- Avoid breastfeeding while you’re taking Enhertu and for 7 months after your last dose. It's not clear if the medication can get into breast milk. But if it does, there’s a potential risk that it could harm your baby. Talk to your care team about safer ways to feed your baby.
- If you're planning on fathering a child, talk to your care team before starting Enhertu. This medication might affect your fertility (or your ability to have children). Your care team can discuss with you about family planning and find the best option for you.
Common questions about Enhertu
No. Enhertu isn't considered traditional chemotherapy. It's a type of targeted therapy. Targeted therapies work more precisely than regular chemotherapy. Instead of attacking all fast-growing cells in the body, they work against specific cancer cells. Enhertu works to kill cancer cells that specifically have the HER2 protein on them.
Some side effects of Enhertu might get better over time. But others can last throughout treatment. Nausea and vomiting are common during the first several cycles. They usually improve over time, but there's still a chance that you could have these side effects later on. Low blood counts typically get better after a few treatment cycles. But feeling tired and having hair loss can be side effects that often continue during treatment. If any side effects start to interfere with your daily life while taking Enhertu, tell your care team. They can provide supportive medications or other ways to help manage side effects. They can also adjust your treatment plan as needed.
Yes, hair loss is a common side effect of Enhertu. Hair can become thinner and fall out in clumps. This can happen with hair on any part of your body. Talk to your oncology care team if you’re worried about losing your hair. They can suggest ways to help, like using cold caps to reduce hair loss or finding lower-cost or free wigs.
The amount of Enhertu from each infusion can stay in your body for about a month. This is based on the medication's half-life, which estimates how long it takes for half of it to leave your system. Because Enhertu stays in your body for a while, each infusion is given once every 3 weeks. If you have questions about how long Enhertu stays in your system, ask your oncologist.
Enhertu is given once every 3 weeks. It's usually given on day 1 of each 21-day treatment cycle. A nurse will help infuse the medication through a vein at an infusion center or clinic.
You'll usually keep taking Enhertu as long as it's working and you can handle the side effects. People might need to stop if they have serious side effects or a severe reaction to the infusion. Another reason that someone might stop treatment is if their cancer gets worse. Ask your oncologist if you have questions about how long to take Enhertu.
Based on current research, Enhertu isn't a cure for breast cancer. It can't remove all of the cancer. But studies show that it can slow down cancer growth and sometimes even shrink the tumor. Enhertu is approved to treat advanced or metastatic HER2-positive or HER2-low breast cancer. It's also approved to treat advanced or metastatic HR-positive, HER2-low or HER2-ultralow breast cancer. Talk to your oncologist about how Enhertu might help in your breast cancer treatment.
Enhertu (fam-trastuzumab deruxtecan) and Herceptin (trastuzumab) are both cancer medications given through the vein (IV) every 3 weeks. They treat certain breast, stomach, and esophageal cancers. But Enhertu can also treat some lung cancers and other solid tumors. Both contain trastuzumab but work in different ways. Unlike Herceptin, Enhertu also has a chemotherapy part that helps kill cancer cells. Talk to your oncologist to help compare the two medications.
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Risks and warnings for Enhertu
Enhertu can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Lung problems
- Risk factors: History of kidney problems
People who've taken Enhertu have had lung problems. This can include lung inflammation and fluid buildup in the lungs. Although rare, it can be serious and sometimes life-threatening. In studies, lung problems have happened within the first 6 months of treatment.
Tell your care team right away if you have any trouble breathing, cough, fever, or other breathing problems while receiving Enhertu. If this happens, your care team can check out what's going on. You’ll probably need to get lung scans done and take a corticosteroid to lower lung inflammation. Depending on how serious the lung problem is, you might need to pause or stop your Enhertu treatment.
Low white blood cell count (neutropenia)
Enhertu can lower your white blood cell count. This can put you at risk of infection. In studies, a low white blood cell count first happened days or even months after starting treatment. Sometimes, it can drop too low and cause a serious fever.
Before each Enhertu infusion, your care team will check your blood count to make sure it's safe for you to get. Tell them as soon as possible if you have fevers or chills often or feel unwell during treatment. They'll check your blood again. Depending on how low your blood count is, you might need to take a break from Enhertu or stop the medication altogether.
Problems with heart function
Enhertu can sometimes lower how well your heart pumps blood. This is called left-sided heart failure.
Before starting Enhertu, tell your oncologist about your full medical history, especially if you've had any heart problems. You'll also get imaging done of your heart before starting treatment. Your care team will send you to get an echocardiogram (echo) or a MUGA scan.
You might need regular heart scans while taking Enhertu, especially if you have signs of heart failure. Watch for shortness of breath, coughing, swelling in your legs, dizziness, sudden weight gain, and an irregular heartbeat. If this happens, let your care team know. They'll check your heart and might pause or stop treatment if needed.
Harm to an unborn baby
Enhertu can harm an unborn baby if given during pregnancy. If you can become pregnant, your oncologist will have you take a pregnancy test before starting treatment to make sure you’re not pregnant.
If you or your partner can become pregnant, use birth control while you’re taking Enhertu. Women should keep using birth control for 7 months after the last dose of Enhertu. And men should keep using birth control for 4 months after stopping. Call your care team right away if you or your partner becomes pregnant.
Enhertu dosage
Typical dosage for Enhertu
Enhertu is given by a healthcare professional as an infusion through the vein (IV).
The dose depends on your cancer and your weight. Your oncologist will help find the right dose for you.
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Breast cancer, NSCLC, or solid tumors: The typical dose is 5.4 mg/kg given as an IV infusion once every 3 weeks. It's usually given on day 1 of each 21-day treatment cycle.
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Stomach or esophageal cancer: The typical dose is 6.4 mg/kg given as an IV infusion once every 3 weeks. It's usually given on day 1 of each 21-day treatment cycle.
Your oncologist might lower your dose if you have serious side effects from the medication.
What are alternatives to Enhertu?
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