Dr Tarantino on Clinical Implications of the neoCARHP Trial in HER2+ Breast Cancer

“The major shift in clinical practice will be that many more patients [with HER2-positive breast cancer] will be considered for treatment with THP.”

Paolo Tarantino, MD, PhD, a research fellow in the Department of Medicine at Dana-Farber Cancer Institute and Harvard Medical School, discussed the clinical implications of the phase 3 neoCARHP trial (NCT04858529) of taxane therapy in combination with carboplatin, trastuzumab (Herceptin), and pertuzumab (Perjeta; TCHP) vs a taxane plus trastuzumab and pertuzumab (THP) in patients with HER2-positive early breast cancer.

Findings from the study presented during the 2025 ASCO Annual Meeting showed that the regimens produced comparable pathologic complete response rates, and that THP was associated with reduced toxicity compared with TCHP. Tarantino noted that these findings will alter practice, as more patients will be considered for THP. The taxane in the THP regimen for patients with early-stage disease should be paclitaxel, he advocated. This is due to the agent’s tolerability and efficacy that were observed in the phase 2 CompassHER2 pCR trial (NCT04266249), he added.

However, it is still unknown whether 4 or 6 cycles of THP should be given to patients, Tarantino cautioned. CompassHER2 pCR evaluated 4 cycles of therapy, and neoCARHP examined 6 cycles, he added. In the future, oncologists may try to determine whether a patient achieved a pCR after 4 cycles of therapy and evaluate if they need further therapy, he said. The field is moving towards a treatment paradigm where treatment intensity will be tailored to an individual patient’s response to THP prior to surgery, according to Tarantino.

However, the treatment paradigm of HER2-positive early breast cancer may be further affected by new data from the phase 3 DESTINY-Breast11 trial (NCT05113251), which is examining the addition of fam-trastuzumab deruxtecan-nxki (T-DXd; Enhertu) to THP in this patient population, Tarantino explained. Early data from the trial were positive, which may contribute to the addition of T-DXd followed by THP as a therapeutic option in this setting, he concluded.