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Abstract
Background: HER2/neu-positive breast cancer is an aggressive molecular subtype known for rapid progression but favorable response to targeted and cytotoxic regimens.
Objective: To determine the frequency of pathological complete response (pCR) following four cycles of neoadjuvant chemotherapy in patients with HER2/neu-positive early breast cancer.
Methods: This descriptive study was conducted in the Department of Medical Oncology, Khyber Teaching Hospital, Peshawar, from March 2025 to July 2025. A total of 96 female patients aged 18–80 years with HER2-positive early breast cancer (stage 0–IIIA) were enrolled through non-probability consecutive sampling. After receiving four cycles of neoadjuvant chemotherapy, patients were evaluated one-month post-treatment.
Results: The mean patient age was 49.7 ± 9.8 years, and most patients were post-menopausal (58.3%). Pathological complete response was achieved in 34 patients (35.4%), while 62 patients (64.6%) demonstrated residual tumor burden. pCR was significantly associated with age < 50 years (p = 0.041), pre-menopausal status (p = 0.033), and early tumor stage (p = 0.018). Invasive ductal carcinoma exhibited a higher, though non-significant, response compared to invasive lobular carcinoma. Adverse events were generally manageable, with alopecia observed in all patients and neutropenia in 18.8%.
Conclusion: Neoadjuvant chemotherapy yields a substantial pathological response in HER2-positive early breast cancer, particularly among younger and early-stage patients. The pCR rate, although encouraging, remains lower than internationally reported values, likely reflecting variable access to advanced HER2-directed therapies.