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Neratinib

Phase 3

Breast Cancer | Small molecule | Oncology |Puma Biotechnology Inc|Last Updated: Apr 16, 2026

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedDouble-BlindPLACEBO_CONTROLLEDDMCBiomarker
Total Trials10
Total Enrollment3,929
FDA Designations
No designations recorded
Clinical Trials (10)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT00878709Study Evaluating The Effects Of Neratinib After Adjuvant Trastuzumab In Women With Early Stage Breast CancerPHASE3 COMPLETED 2,840Jul 9, 2009Oct 4, 2019Jun 11, 2021494 United States, Australia +38
NCT01008150Phase II Randomized Trial Evaluating Neoadjuvant Therapy With Neratinib and/or Trastuzumab Followed by Postoperative Trastuzumab in Women With Locally Advanced HER2-positive Breast CancerPHASE2 COMPLETED 141Oct 1, 2010Nov 25, 2016Oct 25, 202142 United States, Canada +3
NCT04886531Trial of Pre-operative Neratinib and Endocrine Therapy With Trastuzumab in ER-Positive, HER-2 Positive Breast CancersPHASE2 RECRUITING 30Jul 21, 2022Jul 21, 2027Apr 8, 20264 United States
NCT00915018Study Evaluating Neratinib Plus Paclitaxel VS Trastuzumab Plus Paclitaxel In ErbB-2 Positive Advanced Breast CancerPHASE2 COMPLETED 479Aug 21, 2009Jun 28, 2018Aug 22, 2018195 United States, Australia +33
NCT02236000A Dose-Escalation Study Evaluating the Combination of Trastuzumab Emtansine (T-DM1) With Neratinib in Women With Metastatic HER2-Positive Breast CancerPHASE1 COMPLETED 49Aug 1, 2014Aug 1, 2021Jan 26, 202315 United States
NCT03377387Capecitabine 7/7 Schedule With Neratinib in Patients With Metastatic HER2-Positive Breast CancerPHASE1 ACTIVE NOT_RECRUITING 34Dec 13, 2017Dec 1, 2026Apr 16, 202610 United States
NCT01111825Temsirolimus Plus Neratinib for Patients With Metastatic HER2-Amplified or Triple Negative Breast CancerPHASE1 COMPLETED 99Apr 1, 2010Jul 1, 2016Sep 26, 201812 United States, Denmark +4
NCT00741260Study Evaluating The Combination Of Neratinib And Capecitabine In Solid Tumors And Breast CancerPHASE1 COMPLETED 105Dec 9, 2008Jun 1, 2018Sep 5, 201837 United States, Australia +9
NCT00708903Study to Examine the Effect of HKI-272 on Rhythms of the Heart (Cardiac Repolarization)PHASE1 COMPLETED 60May 1, 2008Jul 1, 2008May 14, 20121 United States
NCT00706030Study Evaluating Neratinib (HKI-272) In Combination With Vinorelbine In Subjects With Solid Tumors And Metastatic Breast CancerPHASE1 COMPLETED 92Apr 29, 2008Jun 7, 2018Aug 9, 201835 United States, Belgium +9
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Study Endpoints
Primary Endpoints
Invasive Disease-free Survival (iDFS) in Neratinib Arm Compared to Placebo Arm at Year 2
From randomization until time of event up to 2 years

Invasive disease-free survival time is defined as the time from date of randomization until the first disease recurrence of the following events: invasive ipsilateral breast tumor recurrence, invasive contralateral breast cancer, local/regional invasive recurrence, distant recurrence and death from any cause.

Kaplan-Meier Estimates of Invasive Disease-free Survival (iDFS) at Year 2 by Treatment Arms
From randomization until time of event up to 2 years
Pathologic Complete Response in Breast and Axillary Lymph Nodes.
At time of surgery, approximately 7 months

Number of participants with no histologic evidence of invasive tumor cells in the surgical breast specimen, axillary nodes after neoadjuvant chemotherapy

Pathologic Complete Response (pCR)
24 weeks

pCR is defined as the lack of all signs of invasive cancer in the breast removed during surgery

Progression-Free Survival
From randomization to disease progression or death, assessed up to 5.3 years

Defined as the interval from the date of randomization until the first date on which recurrence or progression, or death due to any cause, is documented, censored at the last assessable evaluation or at the initiation of new anticancer therapy.

Number of Evaluable Patients With Dose Limiting Toxicity Events in Phase 1
Day 1, 8, and 15 of cycle 1.

If 1 of 3 patients in this cohort experiences a dose limiting toxicity (DLT), 3 more patients will be added at the same dose level. If 0 of 3 initial patients or 1 of 6 patients in an expanded cohort experiences a DLT, the dose for the next cohort will be escalated to dose level 2; otherwise, the combination will be considered too toxic.

Overall Response Rate (ORR) by Measurement of Target Lesions in Phase II
Every 42 days after the start of protocol therapy through disease progression, approximately 2 years

Per Response Evaluation Criteria in Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.

Maximum Tolerated Dose (MTD)
1 year

If 0 of the 3 patients entered at a dose level experiences a DLT, another 3 patients will be treated at the next higher dose level. If 1 of 3 patients in a cohort experiences a DLT, then up to 3 additional patients will be treated at the same dose level. If none of these 3 additional patients experience a DLT, then the dose will be escalated to the next higher dose level. If \> 2 of the initial 3 or 6 patients at a dose level experience a DLT, then the MTD will have been exceeded, and de-escalation is warranted. De-escalation will continue if \> 2 of the initial 3 or 6 patients in a dose level cohort experience a DLT. There will be 2 dose de-escalation levels (dose levels -1 and -2) and one dose escalation (dose level +1) as shown in the table below. If \< 1 of 6 patients, at that dose level, experience a DLT, then that dose level will be confirmed as the MTD.

Objective Response Rate (ORR) (Phase II)
From enrollment date to first documented response, or last tumor assessment, assessed up to two years

ORR is defined as proportion of subjects who achieved confirmed complete response (CR) or partial response (PR) per Response Evaluation Criteria In Solid Tumors Criteria (RECIST) v1.1: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR. A complete or partial response must be confirmed no less than 4-weeks after the criteria for response are initially met.

Number of Participants With Dose Limiting Toxicities
From first dose date to day 21

Number of participants reporting Adverse Events Causing Dose Limiting Toxicities (DLT).

Maximum Tolerated Dose (MTD) of Neratinib
From first dose date to day 21.

MTD reflects the highest dose of neratinib plus capeciteabine that did not cause a selected Grade 3 toxicity in \>= 2 participants, which is any of 1) Grade 3 or 4 non-hematologic toxicity (Grade 3 asthenia was not considered a DLT unless lasting \>3 days, 2) Grade 3 diarrhea lasting \>2 days on optimal medical therapy or associated with fever or dehydration. 3) Grade 4 neutropenia lasting ≥ 3 days or Grade 4 febrile neutropenia, 4) Grade 4 thrombocytopenia lasting ≥3 days or associated with bleeding or requiring platelet transfusion, 5) Delayed recovery \[to ≥ National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) Grade 1 or baseline\] from one of the above listed toxicities that were related to neratinib and/or capecitabine that delayed the initiation of the next dose by more than 3 weeks.

Maximum Tolerated Dose (MTD) of Capecitabine
From first dose date to day 21.

MTD reflects the highest dose of capecitabine in combination with neratinib that did not cause a selected Grade 3 toxicity in \>= 2 participants, which is any of 1) Grade 3 or 4 non-hematologic toxicity (Grade 3 asthenia was not considered a DLT unless lasting \>3 days, 2) Grade 3 diarrhea lasting \>2 days on optimal medical therapy or associated with fever or dehydration. 3) Grade 4 neutropenia lasting ≥ 3 days or Grade 4 febrile neutropenia, 4) Grade 4 thrombocytopenia lasting ≥3 days or associated with bleeding or requiring platelet transfusion, 5) Delayed recovery \[to ≥ National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) Grade 1 or baseline\] from one of the above listed toxicities that were related to neratinib and/or capecitabine that delayed the initiation of the next dose by more than 3 weeks.

QTc interval
3 days
Overall Response Rate
From first dose date to progression or last tumor assessment, up to four years and six months.

Overall Response Rate (ORR), subjects with CR or PR by independent review in subjects with ErbB-2-positive breast cancer treated at the MTD of neratinib in combination with vinorelbine per Response Evaluation Criteria In Solid Tumors Criteria (RECIST) v1.0: Complete Response (CR), disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; and Non-PD for non-target lesions, and no new lesions.

Maximum Tolerated Dose
From Day 1 to Day 21.

Maximum Tolerated Dose (MTD) of Neratinib in combination with vinorelbine in subjects with advanced solid tumors.

Secondary Endpoints
Overall Survival (OS)
Randomization until death due to any cause (up to 119 Months)
Disease-free Survival Including Ductal Carcinoma in Situ (DFS-DCIS) in Neratinib Arm Compared to Placebo Arm at Year 2
From randomization until time of event up to 2 years
Kaplan-Meier Estimates of Disease-free Survival Including Ductal Carcinoma in Situ (DFS-DCIS) at Year 2 by Treatment Arms
From randomization until time of event up to 2 years
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Study Design & Arms
AllocationRANDOMIZED
MaskingQUADRUPLE
ModelPARALLEL
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
NeratinibEXPERIMENTAL240 mg orally daily for one year
PlaceboPLACEBO_COMPARATORorally daily for one year
Arm 1: paclitaxel + trastuzumab then A CACTIVE_COMPARATOR4 cycles of paclitaxel 80 mg/m2 on Days 1, 8, and 15 of a 28-day cycle. Trastuzumab concurrently with paclitaxel weekly for a total of 16 doses (4 mg/kg loading dose, then 2 mg/kg weekly). Following paclitaxel/trastuzumab, standard AC every 21 days for 4 cycles. Following surgery, trastuzumab (8 mg/kg loading dose, then 6 mg/kg) every 3 weeks to complete 1 year of targeted therapy (either preoperative trastuzumab therapy or neratinib therapy)
Arm 2: paclitaxel + neratinib then A CEXPERIMENTAL4 cycles of paclitaxel 80 mg/m2 on Days 1, 8, and 15 of a 28-day cycle. Neratinib 240 mg orally once daily beginning on Day 1 of paclitaxel and continuing through Day 28 of the final cycle of paclitaxel. Following paclitaxel/neratinib therapy, standard AC every 21 days for 4 cycles. Following surgery, trastuzumab (8 mg/kg loading dose, then 6 mg/kg) every 3 weeks to complete 1 year of targeted therapy (either preoperative trastuzumab therapy or neratinib therapy)
Arm 3: paclitaxel + trastuzumab + neratinib then A CEXPERIMENTAL4 cycles of paclitaxel 80 mg/m2 on days 1, 8, and 15 of a 28 day cycle. Trastuzumab concurrently with paclitaxel, weekly for a total of 16 doses (4 mg/kg loading dose, then 2 mg/kg weekly). Neratinib 200 mg orally once daily beginning on Day 1 of paclitaxel and continuing through Day 28 of the final cycle of paclitaxel. Following paclitaxel/trastuzumab/neratinib therapy, standard AC every 21 days for 4 cycles. Following surgery, trastuzumab (8 mg/kg loading dose, then 6 mg/kg) every 3 weeks to complete 1 year of targeted therapy (either preoperative trastuzumab therapy or neratinib therapy)
Arm 3 NR: paclitaxel+trastuzumab+neratinibEXPERIMENTALNon-randomized: 4 cycles of paclitaxel 80 mg/m2 on days 1, 8, and 15 of a 28 day cycle. Trastuzumab concurrently with paclitaxel, weekly for a total of 16 doses (4 mg/kg loading dose, then 2 mg/kg weekly). Neratinib 200 mg orally once daily beginning on Day 1 of paclitaxel and continuing through Day 28 of the final cycle of paclitaxel. Following paclitaxel/trastuzumab/neratinib therapy, standard AC every 21 days for 4 cycles. Following surgery, trastuzumab (8 mg/kg loading dose, then 6 mg/kg) every 3 weeks to complete 1 year of targeted therapy (either preoperative trastuzumab therapy or neratinib therapy)
AEXPERIMENTALWeeks 1-3\* patients receive either (a) Neratinib, (b) Letrozole or Anastrozole or (c) Neratinib + Letrozole or Anastrozole Weeks 4-24 patients receive Neratinib + Letrozole or Anastrozole and Trastuzumab \*Starting drug intervention varies for the first 3 weeks depending on arms: a, b, and c by randomization.
neratinib plus paclitaxelEXPERIMENTAL -
trastuzumab plus paclitaxelACTIVE_COMPARATOR -
Neratinib and T-DM1EXPERIMENTAL -
capecitabine 7/7 with neratinibEXPERIMENTALIn the phase I portion of the study, a 3+3 design will be used. Once the MTD is reached, the phase II portion will enroll up to 24 patients. Capecitabine will be taken orally in AM and PM (at the assigned dose per cohort) 7 days on and 7 days off. Neratinib is given as 240 mg daily continuously without stopping. A cycle is 28 days. Patients will be seen on Day 1 of each cycle (+/- 3 days). The MD has been determined as 240mg of neratinib and 1000mg BID of capecitabine.
Temsirolimus plus NeratinibEXPERIMENTALThis is an open-label, single arm, dose-escalation phase I-II study to determine the maximum tolerated dose (MTD) of temsirolimus with daily neratinib, and to determine the safety and efficacy of this combination when given to patients with advanced breast carcinoma. Patients with trastuzumab-refractory HER2-amplified disease or triple negative disease will be enrolled in both phases of this clinical trial.
Neratinib and Capecitabine (Dose Level 1)EXPERIMENTALNeratinib 160 mg and Capecitabine 1500 mg/m\^2
Neratinib and Capecitabine (Dose Group 2)EXPERIMENTALNeratinib 240 mg and Capecitabine 1500 mg/m\^2
Neratinib and Capecitabine (Dose Group 3)EXPERIMENTALNeratinib 240 mg and Capecitabine 2000 mg/m\^2
Neratinib and Capecitabine (Dose Group 4)EXPERIMENTALNeratinib 200 mg and Capecitabine 2000 mg/m\^2
Neratinib and Capecitabine (Dose Group 5)EXPERIMENTALNeratinib 160 mg and Capecitabine 2000 mg/m\^2
Neratinib and Capecitabine MTD (Dose Group 6)EXPERIMENTALNeratinib and Capecitabine Maximum Tolerated Dose without prior lapatinib
Neratinib and Capecitabine MTD (Dose Group 7)EXPERIMENTALNeratinib and Capecitabine Maximum Tolerated Dose with prior lapatinib
1EXPERIMENTALHKI-272
2PLACEBO_COMPARATORPlacebo
3ACTIVE_COMPARATORMoxifloxacin
neratinib 160 mg + vinorelbineEXPERIMENTALneratinib 160 mg tablets administered daily by mouth, vinorelbine 25 mg/m\^2 administered IV on day 1 and day 8 of 21 day cycle
neratinib 240 mg + vinorelbineEXPERIMENTALneratinib 240 mg tablets administered daily by mouth, vinorelbine 25 mg/m\^2 administered IV on day 1 and day 8 of 21 day cycle
neratinib 240 mg + vinorelbine, No Prior LapatinibEXPERIMENTALneratinib 240 mg tablets administered daily by mouth, vinorelbine 25 mg/m\^2 administered IV on day 1 and day 8 of 21 day cycle
neratinib 240 mg + vinorelbine, Prior LapatinibEXPERIMENTALneratinib 240 mg tablets administered daily by mouth, vinorelbine 25 mg/m\^2 administered IV on day 1 and day 8 of 21 day cycle
Interventions
NameTypeDescription
neratinibDRUG -
placeboOTHER -
PaclitaxelDRUG -
TrastuzumabDRUG -
DoxorubicinDRUG -
CyclophosphamideDRUG -
Letrozole (L) or Anastrozole (A)DRUGL: (2.5 mg) OR A: (1 mg) orally daily (up to a maximum of 24 weeks)\*
T-DM1DRUGDose-Escalation Phase (Part 1) - Trastuzumab emtansine (T-DM1) will be given at 3.6 mg/kg IV Day 1 every 21 days. Dose-evaluation Phase (Part 2) - Trastuzumab emtansine (T-DM1) will be given at 3.6 mg/kg IV Day 1 every 21 days.
CapecitabineDRUGCapecitabine will be taken orally in AM and PM (at the assigned dose per cohort) 7 days on and 7 days off. Phase II MD 1000mg BID of capecitabine.
EORTC QLQ - BR23, EQ-5D-5L, EORTC QLQ-C30BEHAVIORALQuestionnaires Every Cycle (+/- 3 days) (For phase II)
TemsirolimusDRUG28 day treatment cycle Phase 1 * Weekly intravenously (IV) on days 1, 8, 15, and 22 * Starting dose 8 mg IV weekly (dose level 1). Three patients initially enrolled in each cohort Phase 2 * Dose escalation cohort - 8 mg IV weekly on Days 1, 8, 15, and 22, and then 15 mg IV weekly starting on Day 29 * HER2-amplified and Triple negative - 8 mg IV weekly on Days 1, 8, 15, and 22
MoxifloxacinDRUG -
vinorelbineDRUG -
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Eligibility Criteria
Age Range18 Years — N/A
SexFEMALE
Healthy VolunteersNo
Study Sites494

Inclusion Criteria: * Stage II through IIIC HER-2/erbB-2 positive breast cancer with node positive disease. * Been treated for early breast cancer with standard of care duration of trastuzumab. * Could have been treated neoadjuvantly but have not reached pathologic complete response. Exclusion Cri...

Countries:United StatesAustraliaBelgiumBrazilBulgariaCanadaChinaColombiaCroatiaCzechiaDenmarkFranceGermanyGreeceHong KongHungaryIsraelItalyJapanLithuaniaMalaysiaMaltaMexicoNetherlandsNew ZealandNorth MacedoniaPeruPolandRomaniaSerbiaSingaporeSlovakiaSouth KoreaSpainSwedenSwitzerlandTaiwanThe BahamasTurkey (Türkiye)United KingdomPuerto RicoBelarusIndiaLatviaPortugalSouth AfricaUkraineRussia
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Competitive Landscape -Breast Cancer 408 trials
CompanyTickerTrialsLead PhaseDrugs
Merck & Co., Inc.MRK12PHASE3Pembrolizumab, Paclitaxel, Doxorubicin, Epirubicin, Cyclophosphamide
AstraZeneca PLCAZN47PHASE3Fulvestrant, Capivasertib, Trastuzumab Deruxtecan, Paclitaxel, Trastuzumab
Gilead Sciences, Inc.GILD13PHASE3Sacituzumab Govitecan-hziy, Eribulin, Capecitabine Product, Gemcitabine, Vinorelbine
Eli Lilly and CompanyLLY27PHASE3Abemaciclib, Standard Adjuvant Endocrine Therapy, Imlunestrant, Tamoxifen, Anastrozole
BioNTech SE Sponsored ADRBNTX7PHASE3DB-1303/BNT323, T-DM1, Capecitabine, Paclitaxel, Nab-paclitaxel
Novartis AG Sponsored ADRNVS30PHASE3Ribociclib, Alpelisib, Fulvestrant, Trastuzumab, Pertuzumab
Olema Pharmaceuticals, Inc.OLMA5PHASE3Palazestrant, Fulvestrant, Anastrozole, Letrozole, Exemestane
Pfizer Inc.PFE34PHASE3ARV-471, Fulvestrant, PF-07220060, letrozole, abemaciclib
BeOne Medicines Ltd. Sponsored ADRONC6PHASE3BGB-43395, Letrozole, Abemaciclib, Palbociclib, Ribociclib
Jazz Pharmaceuticals Public Limited CompanyJAZZ3PHASE3Zanidatamab, Trastuzumab, Eribulin, Vinorelbine, Gemcitabine
Celcuity Inc.CELC3PHASE3Gedatolisib, Palbociclib, Fulvestrant, Alpelisib, Arm A: Gedatolisib + Palbociclib + Fulvestrant
Relay Therapeutics, Inc.RLAY2PHASE3RLY-2608, Capivasertib, Fulvestrant, Palbociclib, Ribociclib
GSK plc Sponsored ADRGSK2PHASE3Niraparib
Greenwich LifeSciences, Inc.GLSI1PHASE3GLSI-100
Bristol-Myers Squibb CompanyBMY5PHASE2Iza-bren, Nab-paclitaxel, Paclitaxel, Capecitabine, Carboplatin
BriaCell Therapeutics CorpBCTX2PHASE3SV-BR-1-GM, Cyclophosphamide, Interferon infiltration of the inoculation site, Retifanlimab, Treatment of Physician's Choice
Incyte CorporationINCY4PHASE2Ruxolitinib, Capecitabine, Regorafenib, Pembrolizumab, Axatilimab
Natera, Inc.NTRA3PHASE2Discontinuation of the anti-HER2 maintenance therapy
Puma Biotechnology, Inc.PBYI3PHASE2Neratinib, Loperamide, Colesevelam, Alisertib, Endocrine therapy
Immutep Ltd Sponsored ADRIMMP1PHASE2eftilagimod alpha, Paclitaxel
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Recent Changes (Last 90 Days)
LOWMay 26, 2026NCT04886531primaryCompletionDate: changed
LOWMay 26, 2026NCT03377387primaryCompletionDate: changed
LOWMay 24, 2026NCT04886531studyFirstPostDate: changed
LOWMay 24, 2026NCT03377387studyFirstPostDate: changed