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Breast CancerPhase 2Opti-HER2NCT07421141

De-escalation of Neoadjuvant Treatment (Paclitaxel + HP) in Early HER2+ Breast Cancer

A Phase 2 study testing Paclitaxel, trastuzumab and Pertuzumab in people with Breast Cancer and HER2-positive Breast Cancer, run by National Medical Research Radiological Centre of the Ministry of Health of Russia at 1 site in Russia.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

This phase II study evaluates the efficacy and safety of a de-escalated neoadjuvant chemotherapy regimen in patients with early-stage HER2-positive breast cancer. The experimental regimen consists of 12 weekly cycles of paclitaxel combined with trastuzumab and pertuzumab (THP), without anthracyclines. Read more about this study

Who is it for?
Ages 18 to 75 years, women only
What is being tested?
Paclitaxel, trastuzumab and Pertuzumab
Could I receive a placebo?
No, everyone receives an active treatment
How many people
186 participants
Where
1 siteRussia
Study dates
1 Sep 2023to 30 Dec 2028
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Histologically confirmed invasive breast carcinoma.
  • HER2-positive status defined as IHC 3+ or FISH amplification (ratio >= 2.0).
  • Clinical Stage IIA-IIB (cT1-T2 N0-N1, cT3 N0, M0).
  • Operable disease planned for surgical resection.
  • ECOG performance status 0-1.
  • Left Ventricular Ejection Fraction (LVEF) >= 50% by Echocardiography.
  • Adequate bone marrow, hepatic, and renal function.
  • Signed informed consent form.

Who cannot join

  • Metastatic disease (Stage IV).
  • Prior systemic therapy for breast cancer (chemotherapy, immunotherapy, or anti-HER2 therapy).
  • Serious cardiac history (congestive heart failure, unstable angina, myocardial infarction within 6 months).
  • Other synchronous or metachronous malignancies within 5 years (except non-melanoma skin cancer or carcinoma in situ of the cervix).
  • Pregnancy or breastfeeding.
  • Known hypersensitivity to study drugs.

Trial locations and contacts

1 site in 1 country.

Russia1 site
  • P.A. Hertsen Moscow Oncology Research Institute

    Moscow, 125284

Other trials in Russia

About this study

Official title: Prospective Non-Randomized Phase II Study of De-escalated Neoadjuvant Chemotherapy With Paclitaxel, Trastuzumab, and Pertuzumab (THP) Compared to Standard Regimen (TCHP) in Patients With Early HER2-Positive Breast Cancer

This phase II study evaluates the efficacy and safety of a de-escalated neoadjuvant chemotherapy regimen in patients with early-stage HER2-positive breast cancer. The experimental regimen consists of 12 weekly cycles of paclitaxel combined with trastuzumab and pertuzumab (THP), without anthracyclines.

The study aims to determine if this less toxic regimen can achieve high rates of pathological complete response (pCR) comparable to standard anthracycline-containing regimens. The results are compared with a historical control group of patients who received the standard TCHP regimen (docetaxel, carboplatin, trastuzumab, pertuzumab).

A total of 186 participants are included in the analysis: 93 patients prospectively treated with the de-escalated THP regimen and 93 patients in the retrospective historical control group (TCHP). The primary endpoint is the pCR rate at the time of surgery. Secondary endpoints include toxicity, rate of breast-conserving surgery, and 3-year event-free survival.

Read the detailed description

Background:

Standard neoadjuvant therapy for HER2-positive breast cancer often includes anthracyclines (AC-THP) or platinum-based regimens (TCHP), which are associated with significant toxicity. De-escalation strategies aim to reduce toxicity without compromising efficacy, particularly in patients with early-stage disease.

Study Design:

This is an investigator-initiated, single-center, open-label, non-randomized phase II study.

  • Prospective Cohort (n=93): Patients with Stage IIA-IIB (cT1-2 N0-1, cT3 N0) HER2+ breast cancer receive Paclitaxel (80 mg/m2 weekly for 12 weeks) + Trastuzumab (loading 8 mg/kg, then 6 mg/kg q3w) + Pertuzumab (loading 840 mg, then 420 mg q3w).
  • Historical Control Cohort (n=93): Patients with similar baseline characteristics (Stage IIA-IIB) treated with standard TCHP regimen (Docetaxel 75 mg/m2 + Carboplatin AUC6 + Trastuzumab + Pertuzumab q3w for 6 cycles).

Primary Objective:

To evaluate the pathological complete response (pCR, ypT0/is ypN0) rate in the de-escalated arm.

Secondary Objectives:

  1. To compare the safety profile (incidence of Grade 3-4 adverse events) between THP and TCHP regimens.
  2. To assess the rate of breast-conserving surgery.
  3. To evaluate long-term oncological outcomes (3-year Event-Free Survival).

The study hypothesis is that the de-escalated THP regimen provides a favorable toxicity profile while maintaining high efficacy in a selected population of early HER2+ breast cancer patients.

Keywords
Neoadjuvant Therapy, De-escalation, Paclitaxel, Trastuzumab, Pertuzumab, Pathological Complete Response, THP Regimen
Medical subject headings
Breast Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PaclitaxelDrug

    Also called Taxol

    80 mg/m2 IV weekly for 12 weeks

  • trastuzumabDrug

    Also called Herceptin

    Loading dose 8 mg/kg, then 6 mg/kg IV every 3 weeks

  • PertuzumabDrug

    Also called Perjeta

    Loading dose 840 mg, then 420 mg IV every 3 weeks

  • DocetaxelDrug

    Also called Taxotere

    75 mg/m2 IV every 3 weeks for 6 cycles

  • carboplatinDrug

    Also called Paraplatin

    AUC 6 IV every 3 weeks for 6 cycles

  • Radical SurgeryProcedure or surgery

    Standard radical resection (mastectomy or breast-conserving surgery) with axillary staging (sentinel lymph node biopsy and/or axillary lymph node dissection [Levels I-II], according to current clinical guidelines).

  • Adjuvant Systemic TherapyDrug

    Also called Trastuzumab, T-DM1, Trastuzumab Emtansine

    Risk-adapted post-neoadjuvant treatment based on pathological response:

    • Patients with pCR (ypT≤1a, ypN0, RCB 0-I) receive Trastuzumab to complete 1 year of anti-HER2 therapy (combined with endocrine therapy for luminal subtypes).
    • Patients with residual disease (ypT≥1b and/or ypN+ and/or RCB II-III) receive Trastuzumab emtansine (T-DM1) 3.6 mg/kg every 3 weeks for up to 14 cycles (combined with endocrine therapy for luminal subtypes).

    Adjuvant radiotherapy is administered if clinically indicated.

Study groups in NCT07421141
Study groupRoleWhat they receive
Experimental: De-escalated THPExperimentalPatients receive de-escalated neoadjuvant chemotherapy consisting of 12 weekly cycles of Paclitaxel combined with Trastuzumab and Pertuzumab (THP regimen), followed by surgery.
Receives: Drug: Paclitaxel; Drug: trastuzumab; Drug: Pertuzumab; Procedure: Radical Surgery; Drug: Adjuvant Systemic Therapy
Historical Control: Standard TCHPActive comparatorRetrospective cohort of patients who received standard neoadjuvant chemotherapy with Docetaxel, Carboplatin, Trastuzumab, and Pertuzumab (TCHP regimen) for 6 cycles.
Receives: Drug: trastuzumab; Drug: Pertuzumab; Drug: Docetaxel; Drug: carboplatin; Procedure: Radical Surgery; Drug: Adjuvant Systemic Therapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Pathological Complete Response (pCR) Rate

    Defined as the absence of invasive cancer in the breast and axillary lymph nodes (ypT0/is ypN0) at the time of surgery

    Measured: At the time of surgery (approximately 12-18 weeks after treatment initiation)

Secondary outcomes (3)
  1. Incidence of Grade 3-4 Adverse Events

    Assessment of treatment-related toxicity (neutropenia, diarrhea, etc.) according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0, where Grade 1 is mild, Grade 2 is moderate, Grade 3 is severe, Grade 4 is life-threatening, and Grade 5 is death.

    Measured: From first dose until 30 days after last dose

  2. Rate of Breast-Conserving Surgery

    Proportion of patients eligible for and undergoing breast-conserving surgery

    Measured: At the time of surgery

  3. 3-Year Event-Free Survival (EFS)

    Time from enrollment to disease progression, local recurrence, distant metastasis, or death from any cause

    Measured: 3 years from enrollment

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Feb 2026
  2. Study start1 Sep 2023
  3. Primary completion10 Dec 2025
  4. Study completion30 Dec 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Model description
Prospective single-arm de-escalation cohort compared with a retrospective historical control cohort.
Masking
None (open label)
Enrolment
186 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07421141
Sponsor's protocol ID
Opti-HER2-2023
Other IDs
LEC #962/107
Acronym
Opti-HER2
Status last verified
Feb 2026
First submitted
9 Feb 2026
Last updated
27 Feb 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data will not be shared due to patient confidentiality requirements

Publications

  • Nitz UA, Gluz O, Christgen M, Grischke EM, Augustin D, Kuemmel S, Braun M, Potenberg J, Kohls A, Krauss K, Stefek A, Schumacher C, Forstbauer H, Reimer T, Fischer H, Liedtke C, Wuerstlein R, Schumacher J, Kates R, Kreipe H, Harbeck N. De-escalation strategies in HER2-positive early breast cancer (EBC): final analysis of the WSG-ADAPT HER2+/HR- phase II trial: efficacy, safety, and predictive markers for 12 weeks of neoadjuvant dual blockade with trastuzumab and pertuzumab +/- weekly paclitaxel. Ann Oncol. 2017 Nov 1;28(11):2768-2772. doi: 10.1093/annonc/mdx494.

    PubMed 28945833
  • Waks AG, Desai NV, Li T, Poorvu PD, Partridge AH, Sinclair N, Spring LM, Faggen M, Constantine M, Metzger O, Alberti J, Deane J, Rosenberg SM, Frank E, Tolaney SM, Krop IE, Tung NM, Tayob N, King TA, Mittendorf EA, Winer EP. A prospective trial of treatment de-escalation following neoadjuvant paclitaxel/trastuzumab/pertuzumab in HER2-positive breast cancer. NPJ Breast Cancer. 2022 May 10;8(1):63. doi: 10.1038/s41523-022-00429-7.

    PubMed 35538105
  • Schneeweiss A, Chia S, Hickish T, Harvey V, Eniu A, Hegg R, Tausch C, Seo JH, Tsai YF, Ratnayake J, McNally V, Ross G, Cortes J. Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA). Ann Oncol. 2013 Sep;24(9):2278-84. doi: 10.1093/annonc/mdt182. Epub 2013 May 22.

    PubMed 23704196

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Paclitaxel, trastuzumab and Pertuzumab in people with Breast Cancer and HER2-positive Breast Cancer, run by National Medical Research Radiological Centre of the Ministry of Health of Russia at 1 site in Russia.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 27 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Russia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Pathological Complete Response (pCR) Rate (time frame: At the time of surgery (approximately 12-18 weeks after treatment initiation)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07421141, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Feb 2026.

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