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Eurasian Journal of
Medicine and Oncology Zercepac + pyrotinib versus pertuzumab in HER2+ BC
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ventricular contractions, arrhythmia, sinus tachycardia, 5. Conclusion
sinus bradycardia, sinus arrhythmia, T-wave changes, and
changes in cardiac ejection fraction). However, diarrhea While the HP dual-target regimen remains the neoadjuvant
showed a statistically significant difference (p<0.001): no standard for HER2-positive breast cancer, this study
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cases were reported in the TCbHP group, while all eight highlights the non-inferiority of Zercepac ’s to originator
patients in the TCbHPy group experienced varying degrees trastuzumab, along with its preservative-free formulation
cost-efficiency
HR-negative
and
advantages.
For
of diarrhea. Furthermore, all eight patients in the TCbHPy
group had MP grades above level 4, with a total probability subgroups, the TCbHPy regimen demonstrates
of 75% (6/8) achieving apCR, bpCR, or tpCR. Two out particular promise, achieving high MP regression grades
(100% grade ≥4) despite modest tpCR rates. The 75%
of three tpCR patients were HR-negative. As experience
with Py increased, a triple anti-diarrheal method was apCR/bpCR composite rate and manageable toxicity
implemented for first-level prevention: loperamide (two profile, with appropriate prophylactic measures, suggest
potential clinical utility, although long-term survival
tablets per dose, twice daily, not exceeding eight tablets per
day), smectite powder (one packet per dose, 3 times daily), outcomes (PFS/OS) require validation in larger cohorts.
and bifidobacterium (two packets per dose, twice daily). At present, we are actively collecting and analyzing long-
term follow-up data, including PFS and OS. We plan
Before introducing this regimen, the incidence of diarrhea
in our department included six cases (75%) of Grade 1 to disclose these results in subsequent research reports.
and two cases (25%) of Grade 2, with no unexpected Moving forward, studies should prioritize optimized
dosing strategies and biomarker-driven patient selection
Grade 3 events. Following the introduction of triple anti-
diarrheal therapy, as of the manuscript submission date, to maximize the therapeutic index of Py.
patient compliance in the Py group in our department Acknowledgments
improved significantly. The median duration of diarrhea
was reduced from 7 days to 3 days (interquartile range: None.
2 – 5), and the patient compliance rate increased to 87.5% Funding
(7 out of 8), with an initial dose of 400 mg. The tpCR
rate also improved compared to previous statistics. We None.
recognize that the study’s small sample size and single-
center design may limit the statistical robustness and Conflict of interest
generalizability of the findings. Nevertheless, we believe The authors declare no conflicts of interest.
the results of this research are of substantial value and can
serve as a foundational framework for future large-scale, Author contributions
multicenter investigations. Conceptualization: Hong Gao and Shengying Wang
In real-world clinical practice, the HP dual-target Formal analysis: Jiali Lei and Zhaohua Gui
regimen remains the first choice for neoadjuvant treatment Methodology: Hong Gao, Jiali Lei, and Zhaohua Gui
for HER2-positive breast cancer. Zercepac is not inferior Writing – original draft: Hong Gao
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to Herceptin in terms of efficacy. With its lack of benzyl Writing – review & editing: Shengying Wang
alcohol preservatives and cost advantage, Zercepac can
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further reduce expenses for both patients and healthcare Ethics approval and consent to participate
systems. Moreover, HR and HER2 status are independent This retrospective data analysis study, which involved no
factors influencing tpCR rates across all patients. Based on disclosure of patient identities and complied with ethical
the clinical observations in this study, the trastuzumab + standards, is exempt from obtaining informed consent.
Py regimen, which combines small and large molecules, Data are from Anhui Provincial Cancer Hospital, and its
offers advantages over single-target regimens combined ethical approval is granted by the Ethics Committee of
with chemotherapy. It also shows a modest advantage in Anhui Provincial Cancer Hospital (Approval Number:
improving the MP grading of primary tumors compared 2024-TJK-06).
to regimens based solely on large molecules, especially in
HR-negative, HER2-positive patients. The combination Consent for publication
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of Zercepac and Py with chemotherapy warrants further The authors verbally informed all participants by telephone
investigation. Whether this regimen can benefit improve during data collection and follow-up regarding the intent
PFS or even overall survival (OS) remains to be determined to publish study results, and all participants provided
through future clinical follow-up and data collection. verbal consent.

Volume 9 Issue 3 (2025) 119 doi: 10.36922/EJMO025100044