Comparison of T-DM1 and trastuzumab-pertuzumab in HER2-positive breast cancer patients with residual disease after neoadjuvant therapy: a retrospective study.

backgroundFor HER2-positive early-stage breast cancer patients who have received neoadjuvant chemotherapy with trastuzumab and pertuzumab (HP), it remains unclear whether to intensify treatment with T-DM1 or to continue with HP therapy in the presence of residual disease identified in postoperative pathology.

methodsThis retrospective study included patients at two cancer centers in China from January 2020 to August 2022. Patients were subsequently treated with either continued HP or intensified therapy with T-DM1 for one year. A multivariable Cox proportional hazards regression model was used to identify factors influencing patient outcomes. Propensity score matching(PSM) was employed to mitigate the impact of confounding variables, and disease-free survival(DFS) between the T-DM1 and HP groups was compared.

resultsBefore PSM, 114 patients were included, with 24 in the T-DM1 group and 90 in the HP group. Multivariate analysis revealed that patients in ypStage I/II had a higher DFS than those in ypStage III. In the T-DM1 group, 14 patients (58.3%) experienced thrombocytopenia, with 12 affected during cycles 2 to 4. After PSM, no statistically significant difference in DFS between the two groups (P = 0.48). The 1, 2, and 3-year DFS rates for the T-DM1 group were 94.7%, 94.7%, and 94.7%, respectively, while for the HP group, they were 100%,100%, and 89.5%.

conclusionsIn patients with HER2-positive early breast cancer who have residual disease after receiving neoadjuvant treatment with HP, the continued administration of HP can achieve therapeutic effects comparable to those of T-DM1, without significant complications.