| HER2-positive carcinoma of breast
Nerlynx vs Phesgo
Side-by-side clinical, coverage, and cost comparison for her2-positive carcinoma of breast.Deep comparison between: Nerlynx vs Phesgo with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsPhesgo has a higher rate of injection site reactions vs Nerlynx based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Phesgo but not Nerlynx, including UnitedHealthcare
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Category
Nerlynx
Phesgo
At A Glance
Oral
Once daily
pan-HER kinase inhibitor
SC injection
Every 3 weeks
HER2/neu receptor antagonist
Indications
- HER2-positive carcinoma of breast
- HER2-positive carcinoma of breast
- Inflammatory Breast Carcinoma
- Locally advanced breast cancer
- Carcinoma breast stage IV
Dosing
HER2-positive carcinoma of breast (extended adjuvant, early-stage) 240 mg (6 tablets) orally once daily with food, continuously until disease recurrence or for up to one year; reduce starting dose to 80 mg in severe hepatic impairment (Child Pugh C).
HER2-positive carcinoma of breast (advanced or metastatic) 240 mg (6 tablets) orally once daily with food on Days 1-21 of a 21-day cycle plus capecitabine 750 mg/m2 orally twice daily on Days 1-14 of a 21-day cycle until disease progression or unacceptable toxicities.
HER2-positive carcinoma of breast, Inflammatory Breast Carcinoma, Locally advanced breast cancer Initial dose 1,200 mg pertuzumab / 600 mg trastuzumab / 30,000 units hyaluronidase SC over ~8 min, then maintenance 600 mg pertuzumab / 600 mg trastuzumab / 20,000 units hyaluronidase SC over ~5 min every 3 weeks with chemotherapy; neoadjuvant: 3-6 preoperative cycles then continue to complete 18 total cycles; adjuvant: up to 18 cycles (1 year) starting Day 1 of first taxane-containing cycle.
Carcinoma breast stage IV Initial dose 1,200 mg pertuzumab / 600 mg trastuzumab / 30,000 units hyaluronidase SC over ~8 min, then maintenance 600 mg pertuzumab / 600 mg trastuzumab / 20,000 units hyaluronidase SC over ~5 min every 3 weeks with docetaxel until disease progression or unmanageable toxicity.
Contraindications
—
- Known hypersensitivity to pertuzumab, trastuzumab, hyaluronidase, or any excipient of PHESGO
Adverse Reactions
Most common (>=5%) Diarrhea, nausea, abdominal pain, fatigue, vomiting, rash, stomatitis, decreased appetite, muscle spasms, dyspepsia, AST or ALT increased, nail disorder, dry skin, abdominal distension, epistaxis, weight decreased, urinary tract infection
Serious Diarrhea, vomiting, nausea, dehydration, acute kidney injury, cellulitis, renal failure, erysipelas, ALT increased, AST increased, fatigue, abdominal pain
Most common (>=5%) Alopecia, nausea, diarrhea, anemia, asthenia, fatigue, stomatitis, myalgia, arthralgia, neutropenia, vomiting, constipation, headache, dysgeusia, decreased appetite, peripheral sensory neuropathy, mucosal inflammation, injection site reaction, radiation skin injury, insomnia, cough
Serious Febrile neutropenia, neutropenic sepsis, neutrophil count decreased, cardiomyopathy, pulmonary toxicity
Postmarketing Glomerulopathy, immune thrombocytopenia, tumor lysis syndrome
Pharmacology
Neratinib is an irreversible intracellular kinase inhibitor that binds to EGFR, HER2, and HER4, reducing EGFR and HER2 autophosphorylation and downstream MAPK and AKT signaling pathways.
Pertuzumab blocks HER2 heterodimerization at subdomain II to inhibit MAP kinase and PI3K signaling, trastuzumab binds subdomain IV to inhibit HER2-mediated cell proliferation, and together they augment antibody-dependent cell-mediated cytotoxicity against HER2-overexpressing tumor cells; hyaluronidase transiently depolymerizes hyaluronan to increase subcutaneous tissue permeability and enable systemic absorption.
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Most Common Insurance
Anthem BCBS
Nerlynx
- Covered on 5 commercial plans
- PA (12/12) · Step Therapy (0/12) · Qty limit (11/12)
Phesgo
- Covered on 5 commercial plans
- PA (12/12) · Step Therapy (0/12) · Qty limit (0/12)
UnitedHealthcare
Nerlynx
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (0/8) · Qty limit (3/8)
Phesgo
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Nerlynx
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (2/3)
Phesgo
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
$10/fillfill
Nerlynx Co-pay CardCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
Cost estimate not availableAssistance Fund: Breast Cancer
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.