NURSE AND PATIENT RESOURCES TO GUIDE THE
ENHERTU EXPERIENCE

Help your patients understand the benefits and potential risks of treatment

Indications
ENHERTU is a HER2-directed antibody and topoisomerase inhibitor conjugate indicated for the treatment of adult patients with:

  • Unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting.

    This indication is approved under accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

  • Locally advanced or metastatic HER2-positive gastric or gastroesophageal junction adenocarcinoma who have received a prior trastuzumab-based regimen.

Nurse resources for ENHERTU

Download helpful resources to guide use of ENHERTU

resource

HCP resource guide for patients with HER2+ metastatic breast cancer

resource

Infusion guide for nurses

Videos for nurses

Watch experts discuss the use of ENHERTU in both HER2+ metastatic breast cancer and advanced gastric cancer in their practices.

Patient counseling

Desiree, an oncology Physician Assistant, discusses her experience counseling caregivers and patients receiving ENHERTU.

 

ENHERTU is a HER2-directed antibody and topoisomerase inhibitor conjugate indicated for the treatment of adult patients with unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting.

This indication is approved under accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

ENHERTU is a HER2-directed antibody and topoisomerase inhibitor conjugate indicated for the treatment of adult patients with locally advanced or metastatic HER2-positive gastric or gastroesophageal junction adenocarcinoma who have received a prior trastuzumab-based regimen.

WARNING: INTERSTITIAL LUNG DISEASE and EMBRYO-FETAL TOXICITY

  • Interstitial lung disease (ILD) and pneumonitis, including fatal cases, have been reported with ENHERTU. Monitor for and promptly investigate signs and symptoms including cough, dyspnea, fever, and other new or worsening respiratory symptoms. Permanently discontinue ENHERTU in all patients with Grade 2 or higher ILD or pneumonitis. Advise patients of the risk and to immediately report symptoms.
  • Exposure to ENHERTU during pregnancy can cause embryo-fetal harm. Advise patients of these risks and the need for effective contraception.

Hi, my name is Desiree Grogan and I’ve worked as an oncology Physician Assistant for over 22 years. As part of my job, I have had the opportunity to treat patients who have been prescribed ENHERTU.

Patients who are prescribed ENHERTU have received prior treatment for their cancer. It is important to remember what your patient has already been through when setting expectations about what may be to come with a new therapy.

So, take time to explain why ENHERTU may be the right option for your patient and their kind of cancer at this time.

As you know, some patients will have a lot of questions about how it works, and what they might expect. Taking time to answer their questions will help them feel more confident in this next step with ENHERTU.

I typically tell my patients that ENHERTU is made of an antibody with a chemotherapy attached. It works by targeting HER2-positive cancer cells and delivering chemotherapy to them. I also let them know that while ENHERTU is designed to target HER2-positive cancer cells, it may still affect some healthy cells.

I also try to share some information about the study endpoints seen in the ENHERTU clinical trials.

Remember to carefully explain your patient’s new schedule–not only how often they will need an infusion, but any other points at which they should contact you, including if they experience any signs or symptoms of a side effect or any other concerns.

To prepare for the day of infusion, I usually run them through a simplified version of the infusion process: how long it will take, what we’ll be doing, etc.

I like to remind patients to eat well, stay hydrated, to bring a book, and to have someone prepared to drive them to and from the infusion center.

Regarding the timing of the infusions, I let my patients know that the first infusion typically takes an hour and a half, but later infusions can be as quick as 30 minutes depending on how they tolerate the first infusion.

I always make sure to tell patients that the most common side effects with ENHERTU are nausea, low white blood cell counts, low red blood cell counts, feeling tired, vomiting, hair loss, increased liver function tests, low platelet counts, constipation, decreased appetite, diarrhea, low levels of blood potassium, cough, and fever.

There are also some serious or life-threatening side effects that may affect their lungs, like interstitial lung disease, pneumonitis, their heart, or their ability to fight infection.

I also mention that some side effects may happen sooner than others. Most neutropenic events occur within the first month, but some may happen later. Interstitial lung disease or pneumonitis could occur earlier or later in therapy.

It is important to reiterate that adverse reactions may be managed with medication or ENHERTU dose modifications, and that ENHERTU may be discontinued due to the type, severity, or occurrence of adverse reactions.

Patients should review the ENHERTU medication guide before they receive treatment.

Before your patient starts their treatment with ENHERTU, it’s also important to talk about the possibility of potentially severe or fatal conditions, like interstitial lung disease or pneumonitis, while being treated with ENHERTU, and teach them how to help identify the symptoms.

For example, I tell my patients that interstitial lung disease includes a range of disorders that can affect the lungs over time. It can affect your ability to breathe and get enough oxygen into your bloodstream.

Here are some symptoms related to interstitial lung disease that your patients should look out for and let you know about immediately: cough, trouble breathing or shortness of breath, fever, or other new or worsening breathing symptoms. For example, chest tightness, or wheezing.

Be sure to emphasize that reporting these symptoms promptly can assist their oncology healthcare team in diagnoses and management.

The first thing I like to tell caregivers when a loved one starts ENHERTU is that communication is important. They should talk to their loved one about how they’re feeling so that they can help facilitate any future conversations with their oncology team.

Caregivers are invaluable when looking out for adverse reactions. I always make sure to tell them to monitor for the side effects shown on screen. This is not a complete list of side effects they should look out for. Please refer to the medication guide for more details.

I always make sure to remind caregivers to report any symptoms or things that don’t seem right. No matter how small it may seem, everything is important to consider when undergoing treatment.

In terms of communication between the patient, caregiver, oncology healthcare team, and myself, an open line of communication is always best. Regular, scheduled check-ins with the caregiver or patient are helpful too. This can help with proper management of the patient’s treatment and side effects.

Patients and caregivers don’t always have the same questions or concerns, and it’s so important for all parties to feel like they have all the information they need to feel more confident about treatment. I encourage caregivers to reach out to me any time they need to.

In terms of advice for caregivers and emotional care, it really depends on the patient, of course, so I like to tell them to use their best judgement. Some patients will like to talk about what’s going on, others will want space, a sense of normalcy.

But it’s good to just keep checking in on how the patient is feeling emotionally, mentally, and physically.

There are so many organizations or websites that offer advice and support to caregivers. Cancer.org is a great one.

Please see Important Safety Information in video and on the page.

 

Dosage & administration

Tyler, a pharmacist certified in oncology, demonstrates the dosing and administration process for ENHERTU.

 

ENHERTU is a HER2-directed antibody and topoisomerase inhibitor conjugate indicated for the treatment of adult patients with unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting.

This indication is approved under accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

ENHERTU is a HER2-directed antibody and topoisomerase inhibitor conjugate indicated for the treatment of adult patients with locally advanced or metastatic HER2-positive gastric or gastroesophageal junction adenocarcinoma who have received a prior trastuzumab-based regimen.

WARNING: INTERSTITIAL LUNG DISEASE and EMBRYO-FETAL TOXICITY

  • Interstitial lung disease (ILD) and pneumonitis, including fatal cases, have been reported with ENHERTU. Monitor for and promptly investigate signs and symptoms including cough, dyspnea, fever, and other new or worsening respiratory symptoms. Permanently discontinue ENHERTU in all patients with Grade 2 or higher ILD or pneumonitis. Advise patients of the risk and to immediately report symptoms.
  • Exposure to ENHERTU during pregnancy can cause embryo-fetal harm. Advise patients of these risks and the need for effective contraception.

My name is Tyler Redelico. I’ve practiced as a pharmacist since 2015 and I’m board certified in oncology. I’ve used ENHERTU at my practice and I’d like to walk through the preparation and administration with you today. The recommended weight-based dosage differs by indication as shown here. Infusion should occur once every three weeks and continue until disease progression or unacceptable toxicity. ENHERTU should not be substituted with trastuzumab or ado-trastuzumab emtansine. The first dose is infused over 90 minutes and subsequent doses over 30 minutes, as long as previous doses were well tolerated.

If an infusion reaction occurs, slow or interrupt the infusion. The infusion can be restarted when the patient recovers, unless the reaction is severe. With ENHERTU, no post-infusion observation is required. The key steps before administration are reconstitution, dilution, and pre-administration checks. Patients should review the ENHERTU medication guide before they receive treatment.

Prior to administration, it’s important to remember a few key points. The recommended dose for ENHERTU is different per indication. Be sure to consult the package insert for the correct dosage for the type of cancer that’s being treated. ENHERTU is a cytotoxic drug. Follow applicable special handling and disposal procedures. ENHERTU is diluted with 5% Dextrose, not sodium chloride.

Finally, it is important to ensure that ENHERTU is protected from light during storage and dilution. It is advised that you cover the IV infusion bag to ensure it is not exposed to the light. Calculate the dose and remove the appropriate number of 100 milligram vials from the refrigerator.

Reconstitute immediately before dilution. Aseptically reconstitute each vial with 5 milliliters Sterile Water for Injection, USP reaching a final concentration of 20 milligrams per one milliliter.

Swirl the vial gently, do not shake until it completely dissolved. The solution should be clear and colorless to a light yellow. Don’t use if visible particles are present, or if solution is cloudy or discolored. Dilute the calculated volume of reconstituted ENHERTU in an IV bag containing 100 mLs of D5W. ENHERTU is not compatible with sodium chloride.

ENHERTU is compatible with most standard infusion bags, specifically polyvinylchloride, PVC, and polyolefin, which includes polyethylene and polypropylene. Gently invert the bag to thoroughly mix the solution, do not shake. Cover the infusion bag to protect from light.

You will need to monitor complete blood counts (CBC) prior to initiation and prior to each dose, and as clinically indicated. This is to monitor for neutropenia, including febrile neutropenia, and thrombocytopenia, which can occur in patients treated with ENHERTU.

Other labs may need to be checked as indicated.

Also, since patients may be at an increased risk for left ventricular dysfunction with ENHERTU treatment, it is also important to assess LVEF prior to initiation and at regular intervals as clinically indicated.

Lastly, if your patient is female, verify that she is not pregnant. Exposure to ENHERTU during pregnancy can cause embryo-fetal harm.

Once you’re ready to begin the administration, you should check the temperature of the prepared solution. If the prepared infusion solution was stored in a refrigerator at 2 to 8 degrees Celsius or 36 to 46 degrees Fahrenheit, allow the solution to reach room temperature prior to administration.

ENHERTU is compatible with both polyolefin and polybutadiene infusion sets, and should be infused through a 0.2 or 0.22 micron in-line polyethersulfone (PES) or polysulfone (PS) filter. Do not administer as an intravenous push or bolus.

Do not mix ENHERTU with other drugs or administer other drugs through the same IV line. Both polyethylene-lined infusion sets and polyvinylchloride tubing are acceptable for infusion. Remember, prior to initiating and following the administration, flush the in-line filter tubing with D5W.

I always make sure to tell patients that the most common side effects with ENHERTU are nausea, low white blood cell counts, low red blood cell counts, feeling tired, vomiting, hair loss, increased liver function tests, low platelet counts, constipation, decreased appetite, diarrhea, low levels of blood potassium, cough, and fever. Some serious or life-threatening side effects may affect your lungs, heart, or white blood cell count, affecting your ability to fight infection.

I also mention that some side effects may occur sooner than others. Most neutropenic events occur within the first month, but some may happen later. Interstitial lung disease or pneumonitis could occur earlier or later during therapy.

It’s important to reiterate that some adverse events may be managed with other types of medicine or through dose modifications. By far, the key factor to help a patient feel comfortable is communication. It’s so important to gauge how the patient’s feeling both physically and emotionally. Yes, they may have been through cancer treatment before, but it can be nerve-wracking to start a new treatment. They may be on treatment for months, so it’s important that the whole care team works together.

Please see Important Safety Information in video and on the page.

 

ENHERTU is a HER2-directed antibody and topoisomerase inhibitor conjugate indicated for the treatment of adult patients with unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting.

This indication is approved under accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

ENHERTU is a HER2-directed antibody and topoisomerase inhibitor conjugate indicated for the treatment of adult patients with locally advanced or metastatic HER2-positive gastric or gastroesophageal junction adenocarcinoma who have received a prior trastuzumab-based regimen.

WARNING: INTERSTITIAL LUNG DISEASE and EMBRYO-FETAL TOXICITY

  • Interstitial lung disease (ILD) and pneumonitis, including fatal cases, have been reported with ENHERTU. Monitor for and promptly investigate signs and symptoms including cough, dyspnea, fever, and other new or worsening respiratory symptoms. Permanently discontinue ENHERTU in all patients with Grade 2 or higher ILD or pneumonitis. Advise patients of the risk and to immediately report symptoms.
  • Exposure to ENHERTU during pregnancy can cause embryo-fetal harm. Advise patients of these risks and the need for effective contraception.

Hi, my name is Desiree Grogan and I’ve worked as an oncology Physician Assistant for over 22 years. As part of my job, I have had the opportunity to treat patients who have been prescribed ENHERTU.

Patients who are prescribed ENHERTU have received prior treatment for their cancer. It is important to remember what your patient has already been through when setting expectations about what may be to come with a new therapy.

So, take time to explain why ENHERTU may be the right option for your patient and their kind of cancer at this time.

As you know, some patients will have a lot of questions about how it works, and what they might expect. Taking time to answer their questions will help them feel more confident in this next step with ENHERTU.

I typically tell my patients that ENHERTU is made of an antibody with a chemotherapy attached. It works by targeting HER2-positive cancer cells and delivering chemotherapy to them. I also let them know that while ENHERTU is designed to target HER2-positive cancer cells, it may still affect some healthy cells.

I also try to share some information about the study endpoints seen in the ENHERTU clinical trials.

Remember to carefully explain your patient’s new schedule–not only how often they will need an infusion, but any other points at which they should contact you, including if they experience any signs or symptoms of a side effect or any other concerns.

To prepare for the day of infusion, I usually run them through a simplified version of the infusion process: how long it will take, what we’ll be doing, etc.

I like to remind patients to eat well, stay hydrated, to bring a book, and to have someone prepared to drive them to and from the infusion center.

Regarding the timing of the infusions, I let my patients know that the first infusion typically takes an hour and a half, but later infusions can be as quick as 30 minutes depending on how they tolerate the first infusion.

I always make sure to tell patients that the most common side effects with ENHERTU are nausea, low white blood cell counts, low red blood cell counts, feeling tired, vomiting, hair loss, increased liver function tests, low platelet counts, constipation, decreased appetite, diarrhea, low levels of blood potassium, cough, and fever.

There are also some serious or life-threatening side effects that may affect their lungs, like interstitial lung disease, pneumonitis, their heart, or their ability to fight infection.

I also mention that some side effects may happen sooner than others. Most neutropenic events occur within the first month, but some may happen later. Interstitial lung disease or pneumonitis could occur earlier or later in therapy.

It is important to reiterate that adverse reactions may be managed with medication or ENHERTU dose modifications, and that ENHERTU may be discontinued due to the type, severity, or occurrence of adverse reactions.

Patients should review the ENHERTU medication guide before they receive treatment.

Before your patient starts their treatment with ENHERTU, it’s also important to talk about the possibility of potentially severe or fatal conditions, like interstitial lung disease or pneumonitis, while being treated with ENHERTU, and teach them how to help identify the symptoms.

For example, I tell my patients that interstitial lung disease includes a range of disorders that can affect the lungs over time. It can affect your ability to breathe and get enough oxygen into your bloodstream.

Here are some symptoms related to interstitial lung disease that your patients should look out for and let you know about immediately: cough, trouble breathing or shortness of breath, fever, or other new or worsening breathing symptoms. For example, chest tightness, or wheezing.

Be sure to emphasize that reporting these symptoms promptly can assist their oncology healthcare team in diagnoses and management.

The first thing I like to tell caregivers when a loved one starts ENHERTU is that communication is important. They should talk to their loved one about how they’re feeling so that they can help facilitate any future conversations with their oncology team.

Caregivers are invaluable when looking out for adverse reactions. I always make sure to tell them to monitor for the side effects shown on screen. This is not a complete list of side effects they should look out for. Please refer to the medication guide for more details.

I always make sure to remind caregivers to report any symptoms or things that don’t seem right. No matter how small it may seem, everything is important to consider when undergoing treatment.

In terms of communication between the patient, caregiver, oncology healthcare team, and myself, an open line of communication is always best. Regular, scheduled check-ins with the caregiver or patient are helpful too. This can help with proper management of the patient’s treatment and side effects.

Patients and caregivers don’t always have the same questions or concerns, and it’s so important for all parties to feel like they have all the information they need to feel more confident about treatment. I encourage caregivers to reach out to me any time they need to.

In terms of advice for caregivers and emotional care, it really depends on the patient, of course, so I like to tell them to use their best judgement. Some patients will like to talk about what’s going on, others will want space, a sense of normalcy.

But it’s good to just keep checking in on how the patient is feeling emotionally, mentally, and physically.

There are so many organizations or websites that offer advice and support to caregivers. Cancer.org is a great one.

Please see Important Safety Information in video and on the page.

 

ENHERTU is a HER2-directed antibody and topoisomerase inhibitor conjugate indicated for the treatment of adult patients with unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting.

This indication is approved under accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

ENHERTU is a HER2-directed antibody and topoisomerase inhibitor conjugate indicated for the treatment of adult patients with locally advanced or metastatic HER2-positive gastric or gastroesophageal junction adenocarcinoma who have received a prior trastuzumab-based regimen.

WARNING: INTERSTITIAL LUNG DISEASE and EMBRYO-FETAL TOXICITY

  • Interstitial lung disease (ILD) and pneumonitis, including fatal cases, have been reported with ENHERTU. Monitor for and promptly investigate signs and symptoms including cough, dyspnea, fever, and other new or worsening respiratory symptoms. Permanently discontinue ENHERTU in all patients with Grade 2 or higher ILD or pneumonitis. Advise patients of the risk and to immediately report symptoms.
  • Exposure to ENHERTU during pregnancy can cause embryo-fetal harm. Advise patients of these risks and the need for effective contraception.

My name is Tyler Redelico. I’ve practiced as a pharmacist since 2015 and I’m board certified in oncology. I’ve used ENHERTU at my practice and I’d like to walk through the preparation and administration with you today. The recommended weight-based dosage differs by indication as shown here. Infusion should occur once every three weeks and continue until disease progression or unacceptable toxicity. ENHERTU should not be substituted with trastuzumab or ado-trastuzumab emtansine. The first dose is infused over 90 minutes and subsequent doses over 30 minutes, as long as previous doses were well tolerated.

If an infusion reaction occurs, slow or interrupt the infusion. The infusion can be restarted when the patient recovers, unless the reaction is severe. With ENHERTU, no post-infusion observation is required. The key steps before administration are reconstitution, dilution, and pre-administration checks. Patients should review the ENHERTU medication guide before they receive treatment.

Prior to administration, it’s important to remember a few key points. The recommended dose for ENHERTU is different per indication. Be sure to consult the package insert for the correct dosage for the type of cancer that’s being treated. ENHERTU is a cytotoxic drug. Follow applicable special handling and disposal procedures. ENHERTU is diluted with 5% Dextrose, not sodium chloride.

Finally, it is important to ensure that ENHERTU is protected from light during storage and dilution. It is advised that you cover the IV infusion bag to ensure it is not exposed to the light. Calculate the dose and remove the appropriate number of 100 milligram vials from the refrigerator.

Reconstitute immediately before dilution. Aseptically reconstitute each vial with 5 milliliters Sterile Water for Injection, USP reaching a final concentration of 20 milligrams per one milliliter.

Swirl the vial gently, do not shake until it completely dissolved. The solution should be clear and colorless to a light yellow. Don’t use if visible particles are present, or if solution is cloudy or discolored. Dilute the calculated volume of reconstituted ENHERTU in an IV bag containing 100 mLs of D5W. ENHERTU is not compatible with sodium chloride.

ENHERTU is compatible with most standard infusion bags, specifically polyvinylchloride, PVC, and polyolefin, which includes polyethylene and polypropylene. Gently invert the bag to thoroughly mix the solution, do not shake. Cover the infusion bag to protect from light.

You will need to monitor complete blood counts (CBC) prior to initiation and prior to each dose, and as clinically indicated. This is to monitor for neutropenia, including febrile neutropenia, and thrombocytopenia, which can occur in patients treated with ENHERTU.

Other labs may need to be checked as indicated.

Also, since patients may be at an increased risk for left ventricular dysfunction with ENHERTU treatment, it is also important to assess LVEF prior to initiation and at regular intervals as clinically indicated.

Lastly, if your patient is female, verify that she is not pregnant. Exposure to ENHERTU during pregnancy can cause embryo-fetal harm.

Once you’re ready to begin the administration, you should check the temperature of the prepared solution. If the prepared infusion solution was stored in a refrigerator at 2 to 8 degrees Celsius or 36 to 46 degrees Fahrenheit, allow the solution to reach room temperature prior to administration.

ENHERTU is compatible with both polyolefin and polybutadiene infusion sets, and should be infused through a 0.2 or 0.22 micron in-line polyethersulfone (PES) or polysulfone (PS) filter. Do not administer as an intravenous push or bolus.

Do not mix ENHERTU with other drugs or administer other drugs through the same IV line. Both polyethylene-lined infusion sets and polyvinylchloride tubing are acceptable for infusion. Remember, prior to initiating and following the administration, flush the in-line filter tubing with D5W.

I always make sure to tell patients that the most common side effects with ENHERTU are nausea, low white blood cell counts, low red blood cell counts, feeling tired, vomiting, hair loss, increased liver function tests, low platelet counts, constipation, decreased appetite, diarrhea, low levels of blood potassium, cough, and fever. Some serious or life-threatening side effects may affect your lungs, heart, or white blood cell count, affecting your ability to fight infection.

I also mention that some side effects may occur sooner than others. Most neutropenic events occur within the first month, but some may happen later. Interstitial lung disease or pneumonitis could occur earlier or later during therapy.

It’s important to reiterate that some adverse events may be managed with other types of medicine or through dose modifications. By far, the key factor to help a patient feel comfortable is communication. It’s so important to gauge how the patient’s feeling both physically and emotionally. Yes, they may have been through cancer treatment before, but it can be nerve-wracking to start a new treatment. They may be on treatment for months, so it’s important that the whole care team works together.

Please see Important Safety Information in video and on the page.

 

Patient and caregiver resources for ENHERTU

Download resources for your patients and their caregivers

Discussion guide for patients with HER2+ metastatic breast cancer and their healthcare team

Patient brochure for patients with HER2+ metastatic breast cancer

Adverse event management brochure for patients with HER2+ metastatic breast cancer

Caregiver brochure for patients with HER2+ metastatic breast cancer

Patient brochure for patients with HER2+ advanced gastric cancer

Adverse event management brochure for patients with HER2+ advanced gastric cancer

Access and affordability guide for patients

Patient wallet card

Access and financial support resources for ENHERTU

Find helpful resources for you and your patients

ENHERTU4U: Patient Access to Treatment

Support options are available to help your patients who have been prescribed ENHERTU access their treatment.

  • Affordability: Financial and affordability support for your patients
  • Coding & Reimbursement: Coding resources & appeal and claim support
  • Distribution: Find Specialty Distributors and Specialty Pharmacy Providers
  • Field Reimbursement Managers: Provide access and reimbursement support