Review outlines risk-adapted de-escalation strategies for HER2-positive breast cancer

This review examines neoadjuvant therapy options for stage II to III HER2-positive early-stage breast cancer, noting that randomized trial data indicate carboplatin can be safely omitted for most stage II patients, yielding comparable pathological complete response rates with reduced toxicity. The authors discuss de-escalation from a four-drug regimen to weekly paclitaxel with trastuzumab and pertuzumab, and biomarker-guided approaches including chemotherapy-free strategies. They also note that DESTINY-Breast11 and DESTINY-Breast05 established neoadjuvant and postneoadjuvant fam-trastuzumab deruxtecan-nxki as options for high-risk disease, both recently receiving FDA approval, and propose a framework incorporating circulating tumor DNA monitoring and functional imaging as priorities for future study.

Most relevant for: Patients with stage II to III HER2-positive early-stage breast cancer undergoing neoadjuvant therapy planning

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