Neoadjuvant TCHP for Stage II-III HER2-positive Breast Cancer: A Real-world Cohort

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CANASLAN K., DEMİRCİLER E., ARSLAN A. M., TERZİ A., KESKİNKILIÇ M., YAVUZŞEN T.

Journal of Oncological Science, vol.12, no.2, pp.237-246, 2026 (Scopus, TRDizin)

Abstract

Objective: The neoadjuvant combination regimen of taxane, carboplatin, trastuzumab, and pertuzumab (TCHP) is widely used for stage II-III human epidermal growth factor receptor 2 (HER2)-positive breast cancer; however, real-world pathologic complete response (pCR) rates and predictors vary. We evaluated pCR, response correlates, and treatment outcomes in a two-center cohort. Material and Methods: Consecutive non-metastatic HER2-positive patients with clinical T2-4 and/or N1-3 who were treated with neoadjuvant TCHP at two centers from 2022 to 2025 were retrospectively analyzed. pCR was defined as ypT0/is ypN0. Groups were compared, and univariable logistic regression was used to assess factors associated with pCR. Results: Among 43 patients (median age, 48 years), pCR occurred in 24 patients (55.8%). Hormone receptor (HR)-negative tumors were more frequent in the pCR group (66.7% vs. 31.6%; p=0.033). HR positivity predicted lower odds of pCR (odds ratio: 0.231; 95% confidence interval: 0.064-0.836; p=0.026), whereas age, baseline T/N stage, grade, and Ki-67 were not significant predictors. T- and N- downstaging occurred in 81.4% and 74.4%, respectively. Radiologic-pathologic agreement was limited (breast κ=0.272; axilla κ=0.081). Grade 3-4 toxicity was 11.6% (cardiotoxicity 4.7%). Breast-conserving surgery was performed in 72.1%; sentinel lymph node biopsy was performed in 79.1%. Median follow-up was 18 months, with one local recurrence and no deaths. Conclusion: Real-world neoadjuvant TCHP achieved a 55.8% pCR rate with substantial downstaging. HR-negative disease was the key correlate, and imaging CR was an unreliable surrogate for pCR.