{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T06:20:43Z","timestamp":1773037243104,"version":"3.50.1"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"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. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The 4AC-4THP regimen\u2014comprising doxorubicin and cyclophosphamide followed by docetaxel, trastuzumab, and pertuzumab\u2014has been widely adopted as neoadjuvant treatment for HER2-positive breast cancer. While efficacy data are well established, real-world safety data remain limited, particularly in Southeast Asian populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the comprehensive toxicity profile of the 4AC-4THP regimen, including both cardiac and non-cardiac adverse events, in Vietnamese patients with HER2-positive early-stage breast cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective multicenter study involving 52 women with stage II\u2013III HER2-positive breast cancer treated with the 4AC-4THP neoadjuvant regimen at three oncology centers in Northern Vietnam between January 2020 and October 2024. Cardiotoxicity was assessed by serial echocardiography. Non-cardiac adverse events were graded according to CTCAE v5.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No patients developed symptomatic heart failure or experienced a decline in left ventricular ejection fraction (LVEF) below 50%. Subclinical LVEF reduction was observed in 78.8% of patients, with a mean decline of 8.05%, mostly during the anthracycline phase. Hematologic toxicities included neutropenia (42.3%, with 19.2% grade 3\u20134), anemia (46.2%), and thrombocytopenia (19.2%). Non-hematologic toxicities included fatigue\/anorexia (76.9%), oral mucositis (67.3%), alopecia (100%), peripheral neuropathy (48.1%), and diarrhea (9.6%). All toxicities were manageable; no treatment-related deaths or discontinuations were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The 4AC-4THP neoadjuvant regimen in HER2-positive breast cancer showed acceptable tolerability in Vietnamese patients, especially among younger, low-comorbidity Asian populations. Subclinical cardiac dysfunction was common but mild and manageable. These findings provide further support for its use in neoadjuvant settings with appropriate monitoring strategies, especially in real-world clinical settings with variable access to monitoring resources.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1678865","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T05:30:20Z","timestamp":1773034220000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comprehensive toxicity profile of the 4AC-4THP neoadjuvant regimen in HER2-positive breast cancer: a multicenter real-world study in Vietnam"],"prefix":"10.3389","volume":"16","author":[{"given":"Anh Dinh","family":"Tran","sequence":"first","affiliation":[{"name":"Department of Oncology, Hanoi Medical University","place":["Hanoi, Vietnam"]},{"name":"Oncology Center, Hanoi Medical University Hospital, Hanoi Medical University","place":["Hanoi, Vietnam"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Le Huy","family":"Trinh","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hanoi Medical University","place":["Hanoi, Vietnam"]},{"name":"Oncology Center, Hanoi Medical University Hospital, Hanoi Medical University","place":["Hanoi, Vietnam"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tuan Anh","family":"Pham","sequence":"additional","affiliation":[{"name":"Vietnam National Cancer Hospital","place":["Hanoi, Vietnam"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"B1","unstructured":"Cancer today"},{"key":"B2","unstructured":"Breast cancer HER2 status | What is HER2 status"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2024.1446414","article-title":"HER2-targeted therapies for HER2-positive early-stage breast cancer: present and 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