Olubukola Ayodele, Breast Cancer Lead at University Hospitals of Leicester NHS Trust, shared a post on LinkedIn:
“One of the trials on my list at ESMO Breast 2026 was the PHERGain-2 study, exploring whether some patients with HER2-positive early breast cancer can safely avoid chemotherapy altogether.
This is an important study in the era of treatment de-escalation and precision oncology.
For years, chemotherapy has been a key component of treatment for HER2+ early breast cancer. While highly effective, it is also associated with both short and long-term toxicities. The challenge has been identifying which patients may achieve excellent outcomes with less treatment intensity.
PHERGain-2 evaluated a chemotherapy-free, response-adapted approach using trastuzumab + pertuzumab (HP) before surgery. Patients achieving a pathological complete response (pCR) continued HER2-directed therapy without chemotherapy, while those with residual disease received adjuvant T-DM1.
Key findings from the abstract:
- 396 patients with untreated HER2+ early breast cancer were enrolled.
- pCR was achieved in 59.6% following neoadjuvant HP alone.
- Nearly 6 in 10 patients avoided conventional chemotherapy.
- Quality of life outcomes appeared favourable overall.
- Toxicities were largely in keeping with expected HP/T-DM1 profiles.
However, it is important to interpret these results in context.
These were carefully selected patients with node-negative HER2+ disease and relatively small tumours, with a maximum tumour diameter of 5–30 mm confirmed on central MRI review. This is therefore not representative of all HER2+ early breast cancer populations we see in routine clinical practice.
The study nevertheless provides an exciting signal that some biologically selected patients may achieve excellent outcomes without cytotoxic chemotherapy.
Importantly, the long-term recurrence-free survival data are still awaited and will ultimately determine whether this approach can safely change practice.
For now, PHERGain-2 reinforces an important principle in oncology: The future is not only about giving more treatment, but about giving the right treatment to the right patient.
A very important trial to watch.”
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