Management of neutropenia with ENHERTU1

Severe neutropenia, including febrile neutropenia, can occur in patients treated with ENHERTU.

  • In patients with metastatic breast cancer and other solid tumors treated with ENHERTU 5.4 mg/kg, a decrease in neutrophil count was reported in 65% of patients treated with ENHERTU 5.4 mg/kg and above. Sixteen percent had Grade 3 or 4 events. Median time to first onset was 22 days (range: 2 to 664). Febrile neutropenia was reported in 1.1% of patients
  • Monitor complete blood counts prior to initiation of ENHERTU and prior to each dose, and as clinically indicated
  • Based on the severity of neutropenia, manage through treatment interruption or dose reduction

Dose modifications for neutropenia1

Severity Treatment modification
Grade 3
(ANC less than 1.0 to 0.5 x 109/L)
  • Interrupt ENHERTU until resolved to Grade 2 or less, then maintain dose
Grade 4
(ANC less than 0.5 x 109/L)

Toxicity grades are in accordance with NCI-CTCAE v.5.0.

Dose modifications for febrile neutropenia1

Severity Treatment modification
Absolute neutrophil count of less than 1.0 x 109/L and temperature greater than 38.3°C or a sustained temperature of ≥38°C for more than one hour

Toxicity grades are in accordance with NCI-CTCAE v.5.0.

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ANC, absolute neutrophil count; HER2, human epidermal growth factor receptor 2; NCI-CTCAE, National Cancer Institute–Common Terminology Criteria for Adverse Events.