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Comparative Study
. 2025 Jun;211(3):743-752.
doi: 10.1007/s10549-025-07694-7. Epub 2025 Apr 11.

Comparison of paclitaxel and docetaxel in dual HER2 blockade: efficacy and safety in neoadjuvant treatment of HER2-positive breast cancer

Ezgi Turkoglu  1 , Goncagul Akdag Topal  2 , Sedat Yildirim  3 , Oguzcan Kinikoglu  3 , Nisanur Sariyar Busery  3 , Miray Aydogan  3 , Hacer Sahika Yildiz  3 , Seval Orman  3 , Ayberk Bayramgil  4 , Tugce Kubra Gunes  4 , Mustafa Alperen Tunc  5 , Nargiz Majidova  6 , Deniz Isik  3 , Sermin Kokten  7 , Hatice Odabas  3 , Nedim Turan  3
Affiliations
Comparative Study

Comparison of paclitaxel and docetaxel in dual HER2 blockade: efficacy and safety in neoadjuvant treatment of HER2-positive breast cancer

Ezgi Turkoglu et al. Breast Cancer Res Treat. 2025 Jun.

Abstract

Background: Dual HER2 blockade with trastuzumab and pertuzumab combined with neoadjuvant chemotherapy improves outcomes in HER2-positive breast cancer. The optimal taxane backbone (paclitaxel vs. docetaxel) remains unclear.

Methods: This retrospective study included 220 HER2-positive breast cancer patients treated with anthracycline-based chemotherapy followed by dual HER2 blockade with trastuzumab, pertuzumab, and either paclitaxel (80 mg/m2 for 12 weeks) or docetaxel (75 mg/m2 every three weeks for four cycles). Pathological complete response (pCR), disease-free survival (DFS), overall survival (OS), and toxicity profiles were analyzed.

Results: At the time of diagnosis, 6% of the patients included in the study were at stage I, 70.4% were at stage II, and 23.6% were at stage III. The overall pCR rate was 55%, with no significant difference between the paclitaxel (57.9%) and docetaxel (52.2%) groups (p = 0.418). Higher pCR rates were associated with grade 3 tumors, ER/PR negativity, and Ki- 67 ≥ 20%. Patients achieving pCR had significantly lower relapse rates (2.5% vs. 16.2%, p < 0.001). These factors were significantly associated with pCR in univariate analysis but did not remain independent predictors in multivariate analysis. DFS and OS were higher in the paclitaxel group compared to the docetaxel group (DFS: 96.3% vs. 83.2%, p = 0.025; OS: 100% vs. 95.5%, p = 0.042). Grade 3-4 anemia was more frequent with docetaxel (23% vs. 9%, p = 0.007).

Conclusion: Both paclitaxel and docetaxel are effective in neoadjuvant dual HER2 blockade regimens. Paclitaxel demonstrated better DFS, OS, and a favorable safety profile, supporting its use as a preferred option.

Keywords: Docetaxel; HER2-positive breast cancer; Neoadjuvant; Paclitaxel; Pertuzumab; Trastuzumab.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: The study was conducted in compliance with the ethical principles outlined in the Declaration of Helsinki and was approved by the Kartal Dr. Lütfi Kırdar City Hospital Scientific Research Ethics Committee (Approval Date: 25.09.2024; Decision No: 202 Jl0 l0.99/8/l6).

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