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Background <p>Anthracycline-free neoadjuvant chemotherapy combined with dual HER2 blockade represents an alternative to anthracycline-containing regimens in early-stage HER2-positive breast cancer; however, real-world evidence remains limited.</p> Methods <p>We retrospectively analyzed 162 patients with stage I–III HER2-positive breast cancer treated with neoadjuvant trastuzumab and pertuzumab between 2022 and 2025. Patients received anthracycline-free (TCHP/TCH; <i>n</i> = 51) or anthracycline-containing (AC-THP/AC-TH; <i>n</i> = 111) chemotherapy. The primary endpoint was pathological complete response (pCR; ypT0/is ypN0). Secondary endpoints included treatment-related toxicity and cardiac safety.</p> Results <p>The overall pCR rate was 56.8%. pCR was achieved in 64.7% of patients in the TCHP/TCH group and 53.2% in the AC-THP/AC-TH group (<i>p</i> = 0.168). In multivariable analysis, age &gt; 65 years was associated with a lower probability of pCR (OR 0.08; 95% CI, 0.01–0.57), while hormone receptor–negative status was associated with higher pCR rates (OR 2.21; 95% CI, 1.02–4.76). Grade 3–4 hematologic and gastrointestinal toxicities differed between regimens. Cardiac toxicity was rare and similar between groups.</p> Conclusions <p>In a real-world setting, anthracycline-free neoadjuvant chemotherapy with dual HER2 blockade achieved pCR rates comparable to anthracycline-containing regimens with acceptable toxicity and preserved cardiac safety, suggesting that it may be a reasonable treatment option for selected patients.</p>

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Neoadjuvant anthracycline-free versus anthracycline-containing chemotherapy combined with dual HER2 blockade in HER2-positive breast cancer: a real-world comparative study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月28日

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  • Asli Buyukkuscu,
  • Zehra Sucuoglu Isleyen,
  • Omer Burak Ekinci,
  • Tugay Atasever,
  • Kubra Akkaya,
  • Okan Aydin,
  • Gamze Kulduk,
  • Emir Celik,
  • Kayhan Erturk,
  • M. Mustafa Atci

摘要

Background

Anthracycline-free neoadjuvant chemotherapy combined with dual HER2 blockade represents an alternative to anthracycline-containing regimens in early-stage HER2-positive breast cancer; however, real-world evidence remains limited.

Methods

We retrospectively analyzed 162 patients with stage I–III HER2-positive breast cancer treated with neoadjuvant trastuzumab and pertuzumab between 2022 and 2025. Patients received anthracycline-free (TCHP/TCH; n = 51) or anthracycline-containing (AC-THP/AC-TH; n = 111) chemotherapy. The primary endpoint was pathological complete response (pCR; ypT0/is ypN0). Secondary endpoints included treatment-related toxicity and cardiac safety.

Results

The overall pCR rate was 56.8%. pCR was achieved in 64.7% of patients in the TCHP/TCH group and 53.2% in the AC-THP/AC-TH group (p = 0.168). In multivariable analysis, age > 65 years was associated with a lower probability of pCR (OR 0.08; 95% CI, 0.01–0.57), while hormone receptor–negative status was associated with higher pCR rates (OR 2.21; 95% CI, 1.02–4.76). Grade 3–4 hematologic and gastrointestinal toxicities differed between regimens. Cardiac toxicity was rare and similar between groups.

Conclusions

In a real-world setting, anthracycline-free neoadjuvant chemotherapy with dual HER2 blockade achieved pCR rates comparable to anthracycline-containing regimens with acceptable toxicity and preserved cardiac safety, suggesting that it may be a reasonable treatment option for selected patients.