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Simple Summary  Neoadjuvant chemotherapy strategy (NAC) is a standard of care for Human Epidermal Growth Factor Receptor-2 ( HER2 )-positive early breast cancer but there is no proven beneficial evidence in terms of survival compared to the adjuvant chemotherapy strategy. Our retrospective study found a survival benefit in NAC strategy particularly in clinical Nodepositive and postmenopausal patients.Abstract  Background: No survival benefit has yet been demonstrated for neoadjuvant chemotherapy (NAC) against  HER2 -positive tumors in patients with early breast cancer (BC). The objective of this study was to compare the prognosis of  HER2 -positive BC patients treated with NAC to that of patients treated with adjuvant chemotherapy (AC). Materials and methods: We retrospectively analyzed disease-free (DFS) and overall survival (OS) in 202  HER2 -positive patients treated with NAC and 701 patients treated with AC. All patients received trastuzumab in addition to chemotherapy. Patient data were weighted by a propensity score to overcome selection bias. Results: After inverse probability of treatment weights (IPTW) adjustment, no difference in DFS ( p  = 0.3) was found between treatments for the total population. However, after multivariate analysis, an interaction was found between cN status and chemotherapy strategy (IPTW-corrected corrected Hazard ratio cHR = 0.52, 95% CI (0.3–0.9),  p  interaction  = 0.08) and between menopausal status and chemotherapy (CT) strategy (cHR = 0.35, 95%CI (0.18–0.7))  p  interaction  < 0.01). NAC was more beneficial than AC strategy in cN-positive patients and in postmenopausal patients. Moreover, after IPTW adjustment, the multivariate analysis showed that the neoadjuvant strategy conferred a significant OS benefit (cHR = 0.09, 95%CI [0.02–0.35],  p  < 0.001). Conclusion: In patients with  HER2 -positive BC, the NAC strategy is more beneficial than the AC strategy, particularly in cN-positive and postmenopausal patients. NAC should be used as a first-line treatment for  HER2 -positive tumors.

cancers

HER2-Positive Breast Cancer Patients with Pre-Treatment Axillary Involvement or Postmenopausal Status Benefit from Neoadjuvant Rather than Adjuvant Chemotherapy Plus Trastuzumab Regimens