Comparative Effectiveness and Safety of Three Taxanes in Neoadjuvant Therapy for HER2- Positive Breast Cancer: A Real-World Retrospective Study with Inverse Probability of Treatment Weighting

Comparative Effectiveness and Safety of Three Taxanes in Neoadjuvant Therapy for HER2- Positive Breast Cancer: A Real-World Retrospective Study with Inverse Probability of Treatment Weighting | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Effectiveness and Safety of Three Taxanes in Neoadjuvant Therapy for HER2- Positive Breast Cancer: A Real-World Retrospective Study with Inverse Probability of Treatment Weighting XIAOLIU JIANG, JIE LONG, ZHAOHUI HUANG, JIAN KANG, HUIFEN XIONG, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9267365/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: Taxane-based chemotherapy plus dual anti-HER2 targeted therapy is the standard neoadjuvant chemotherapy (NAC) regimen for HER2-positive breast cancer. But comparative efficacy and safety of taxanes remain unclear. This study aimed to evaluate these outcomes for docetaxel (DOC), liposome paclitaxel (Lps-P) and nanoparticle albumin-bound paclitaxel (Nab-P) in HER2+ breast cancer patients who received TCbHP-based NAC. Methods: 216 patients who underwent TCbHP-based NAC between Jan 2017-Dec 2025 were enrolled. Inverse probability of treatment weighting (IPTW) balanced baseline characteristics. Pathological complete response (pCR) rates and adverse events were compared before and after IPTW. Subgroup analyses were performed to explore the pCR rate differences and logistic regression analyses to identify independent predictors of pCR. Results: After IPTW adjustment, the pCR rates of the DOC, Lps-P, and Nab-P groups were 66.5%, 53.9%, and 72.1%, respectively (p=0.101). The Nab-P group showed significantly higher pCR rate than the Lps-P group in ER‑negative (83.1% vs. 56.8%, p=0.021) and PR‑negativesubgroups (83.8% vs. 55.8%, p=0.009). The DOC group showed a lower incidence of grade I-II leukopenia and neutropenia than the Nab-P group. Rates of severe (grade III-IV) hematological toxicities and liver function impairment were similar among the three groups. Multivariate analyses identified age ≥ 50 years, ER‑negative and HER2 IHC 3+ as independent predictors of pCR. Conclusion: There was no significant difference in pCR rates among the three taxanes for HER2+ breast cancer with TCbHP-based NAC. However, Nab-P had superior efficacy in ER/PR‑negativesubgroups with distinct safety profiles, supporting individualized taxane selection based on patient characteristics and toxicity. HER2-positive breast cancer Neoadjuvant chemotherapy Taxane Pathological complete response Inverse probability of treatment weighting Full Text Additional Declarations No competing interests reported. Supplementary Files TableS1.docx FigureS1.docx FigureS2.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 21 Apr, 2026 Editor invited by journal 31 Mar, 2026 Editor assigned by journal 31 Mar, 2026 Submission checks completed at journal 31 Mar, 2026 First submitted to journal 30 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9267365","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":630911130,"identity":"e9d8db20-17b1-4ff1-9adc-6247b39d6289","order_by":0,"name":"XIAOLIU JIANG","email":"","orcid":"","institution":"Third Hospital of Nanchang","correspondingAuthor":false,"prefix":"","firstName":"XIAOLIU","middleName":"","lastName":"JIANG","suffix":""},{"id":630911131,"identity":"9bfd8994-c03e-40a5-8bf5-8ca4c21303ad","order_by":1,"name":"JIE LONG","email":"","orcid":"","institution":"Third Hospital of 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Weighting","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HER2-positive breast cancer, Neoadjuvant chemotherapy, Taxane, Pathological complete response, Inverse probability of treatment weighting","lastPublishedDoi":"10.21203/rs.3.rs-9267365/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9267365/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eTaxane-based chemotherapy plus dual anti-HER2 targeted therapy is the standard neoadjuvant chemotherapy (NAC) regimen for HER2-positive breast cancer. But comparative efficacy and safety of taxanes remain unclear. This study aimed to evaluate these outcomes for docetaxel (DOC), liposome paclitaxel (Lps-P) and nanoparticle albumin-bound paclitaxel (Nab-P) in HER2+ breast cancer patients who received TCbHP-based NAC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003e216 patients who underwent TCbHP-based NAC between Jan 2017-Dec 2025 were enrolled. Inverse probability of treatment weighting (IPTW) balanced baseline characteristics. Pathological complete response (pCR) rates and adverse events were compared before and after IPTW. Subgroup analyses were performed to explore the pCR rate differences and logistic regression analyses to identify independent predictors of pCR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAfter IPTW adjustment, the pCR rates of the DOC, Lps-P, and Nab-P groups were 66.5%, 53.9%, and 72.1%, respectively (p=0.101). The Nab-P group showed significantly higher pCR rate than the Lps-P group in ER‑negative (83.1% vs. 56.8%, p=0.021) and PR‑negativesubgroups (83.8% vs. 55.8%, p=0.009). The DOC group showed a lower incidence of grade I-II leukopenia and neutropenia than the Nab-P group. Rates of severe (grade III-IV) hematological toxicities and liver function impairment were similar among the three groups. Multivariate analyses identified age ≥ 50 years, ER‑negative and HER2 IHC 3+ as independent predictors of pCR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e There was no significant difference in pCR rates among the three taxanes for HER2+ breast cancer with TCbHP-based NAC. However, Nab-P had superior efficacy in ER/PR‑negativesubgroups with distinct safety profiles, supporting individualized taxane selection based on patient characteristics and toxicity.\u003c/p\u003e","manuscriptTitle":"Comparative Effectiveness and Safety of Three Taxanes in Neoadjuvant Therapy for HER2- Positive Breast Cancer: A Real-World Retrospective Study with Inverse Probability of Treatment Weighting","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-29 12:41:37","doi":"10.21203/rs.3.rs-9267365/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-21T11:11:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-31T08:49:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-31T05:40:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-31T05:40:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2026-03-30T13:02:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"71cdef33-2f3b-40fa-bf9a-ac956ee32b89","owner":[],"postedDate":"April 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T12:41:37+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-29 12:41:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9267365","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9267365","identity":"rs-9267365","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}