Neoadjuvant pyrotinib for HER2 (IHC 2+/FISH+)/HR+ breast cancer with early non-response: a case report and literature review.

Authors

Jiani Liu, Xinyu Peng, Xuhui Huang, Jirui Sun, Dan Geng

Published in

Frontiers in medicine. Volume 13. Pages 1805199. Epub Jul 24, 2026.

Abstract

Neoadjuvant therapy (NAT) has been widely adopted in the multimodal management of HER2-positive breast cancer. Trastuzumab and pertuzumab (HP) combined with chemotherapy is the recommended neoadjuvant regimen for patients with HER2-positive locally advanced breast cancer. Achieving total pathological complete response (tpCR) after NAT is a strong predictor of long-term survival in patients with early-stage or locally advanced breast cancer. Nevertheless, approximately 40% of patients fail to achieve tpCR with this standard approach. Early identification of limited or non-responders and switching to a pyrotinib-containing regimen to improve tpCR currently lack a unified clinical standard. Here, we report a case of HER2 (IHC 2+/FISH+)/hormone receptor (HR)+ breast cancer that was assessed as limited early response after two cycles of standard therapy. The regimen was modified to trastuzumab plus pyrotinib plus nab-paclitaxel, resulting in total pathological complete response (tpCR) with good tolerability; only mild, controllable diarrhea occurred. This response-adapted strategy, based on early response assessment by chest CT, warrants further validation.

PMID:
42569044
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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