{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:18:31Z","timestamp":1790983111285,"version":"4.1.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Neoadjuvant therapy (NAT) has been widely adopted in the multimodal management of HER2-positive breast cancer. Trastuzumab and pertuzumab (HP) combined with chemotherapy is the recommended neoadjuvant regimen for patients with HER2-positive locally advanced breast cancer. Achieving total pathological complete response (tpCR) after NAT is a strong predictor of long-term survival in patients with early-stage or locally advanced breast cancer. Nevertheless, approximately 40% of patients fail to achieve tpCR with this standard approach. Early identification of limited or non-responders and switching to a pyrotinib-containing regimen to improve tpCR currently lack a unified clinical standard. Here, we report a case of HER2 (IHC 2+\/FISH+)\/hormone receptor (HR)+ breast cancer that was assessed as limited early response after two cycles of standard therapy. The regimen was modified to trastuzumab plus pyrotinib plus nab-paclitaxel, resulting in total pathological complete response (tpCR) with good tolerability; only mild, controllable diarrhea occurred. This response-adapted strategy, based on early response assessment by chest CT, warrants further validation.<\/jats:p>","DOI":"10.3389\/fmed.2026.1805199","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:10:21Z","timestamp":1784891421000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Neoadjuvant pyrotinib for HER2 (IHC 2+\/FISH+)\/HR+ breast cancer with early non-response: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiani","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Breast Surgery, Baoding No. 1 Central Hospital, Baoding","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Affiliated Hospital of Hebei University, Baoding","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuhui","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Baoding No. 1 Central Hospital, Baoding","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jirui","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Pathology, Baoding First Central Hospital, Baoding","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Geng","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Baoding No. 1 Central Hospital, Baoding","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3997","DOI":"10.1200\/JCO.2013.50.9984","article-title":"Recommendations for human epidermal growth factor receptor 2 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