
A pathological complete response-guided approach enables treatment optimisation in a selected population with HER2-positive breast cancer in the PHERGain-2 study.
“Current treatments for HER2-positive breast cancer are extremely effective, but it is important that patients with a high likelihood of cure only receive systemic treatment necessary to maximise benefit while minimising toxicity,” highlights Dr Giampaolo Bianchini from IRCCS Ospedale San Raffaele, Milan, Italy, discussing the remarkable results of the PHERGain-2 study presented at the ESMO Breast Cancer 2026 congress (Berlin, 6–8 May). Improving patient quality of life without compromising clinical outcome is today a priority in oncology, and treatment optimisation based on chemotherapy-free regimens continues to prove to be a promising approach. In the study, patients who achieved pathological complete response (pCR; 59.6%) at 1 year following treatment with neoadjuvant trastuzumab–pertuzumab and continued on a chemotherapy-free regimen had a lower incidence of decline in health-related quality of life (HRQoL) of ≥10% compared with patients who did not achieve pCR and continued on ado-trastuzumab emtansine (T-DM1) with/without chemotherapy (37.3% versus 51.9%, respectively) (Abstract 214O).
The PHERGain-2 multicentre, open-label, phase II study aims to optimise treatment and improve quality of life for patients with small (5–30 mm), node-negative, early-stage HER2-positive (immunohistochemistry [IHC] 3+) breast cancer using a de-escalation strategy based on pCR. Overall, 391 of 396 enrolled patients underwent surgery following neoadjuvant treatment. Adjuvant therapy post-surgery was adapted according to response and patients were treated in 3 cohorts: those with pCR continued to receive trastuzumab–pertuzumab (cohort A; n=236); patients with residual invasive disease in the breast and with isolated tumour cells or micrometastases received T-DM1 (cohort B; n=148); and those with 1–3 positive lymph nodes could receive optional adjuvant chemotherapy before T-DM1 (cohort C; n=7). The 72.7% of the study population with hormone receptor (HR)-positive tumours also received endocrine neoadjuvant and adjuvant therapy.
Read full article: https://dailyreporter.esmo.org/esmo-breast-cancer-2026/latest-news/chemotherapy-free-adjuvant-treatment-preserves-quality-of-life-in-her2-positive-early-breast-cancer










