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Peer-reviewedCC BY 4.0Frontiers in Pharmacology

Real-world comparative outcomes of pyrotinib-based versus pertuzumab-based first-line therapy in HER2-Positive advanced breast cancer: a multicenter retrospective cohort study from Xinjiang, China

  • Yimuran Hujiahemaiti1
  • Yinping Ge2
  • Chao Zhang3
  • Gulisire Abdoukerim4
  • Jing Fei5
  • Ruifeng Qi6
  • Yan Li1
  • Xiaoping Ma1
  • Zhenhui Zhao1
  • Li Li1
  • Dan Liu1
  • Bingyu Li1
2 more authors
  • Xiner Zhang1
  • Bing Zhao1
6 affiliations
  1. 1Department of Breast Cancer, Affiliated Tumor Hospital of Xinjiang Medical University
  2. 2Department of Oncology, Yili Kazakh Autonomous Prefecture Friendship Hospital
  3. 3Department of Oncology, The First People’s Hospital of Kashgar Prefecture
  4. 4Department of Oncology, Aksu Prefectural People’s Hospital
  5. 5Department of Oncology, The First Affiliated Hospital of Shihezi University
  6. 6Department of Oncology, People’s Hospital of Bayingolin Mongol Autonomous Prefecture
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Abstract

Background: Direct comparative evidence between taxane plus trastuzumab plus pyrotinib (THPyro) and taxane plus trastuzumab plus pertuzumab (THP) as first-line therapy for HER2-positive advanced breast cancer remains limited.

Methods: This multicenter retrospective real-world cohort study included 181 female patients in Xinjiang, China who initiated first-line THP or THPyro between 1 January 2020 and 30 September 2025. Propensity score matching generated 60 matched pairs. The primary endpoint was progression-free survival (PFS). Median follow-up in the matched cohort was 28.4 months.

Results: After matching, baseline characteristics were well balanced. THPyro showed numerically longer median PFS than THP (20.1 vs. 17.6 months; log-rank P = 0.086), and the stratified Cox model showed a non-significant trend toward reduced progression risk (hazard ratio, 0.478; 95% confidence interval, 0.216–1.061). Restricted mean survival time (RMST) analysis demonstrated a significant 24-month PFS gain with THPyro (absolute difference, 2.41 months; P = 0.007). Objective response and disease control rates were comparable. Brain metastasis status was the most prominent potential effect modifier, with an exploratory signal observed in patients with baseline brain metastases. THPyro was associated with more diarrhea, and higher albumin level and prophylactic loperamide use were associated with a lower observed risk of grade ≥2 diarrhea.

Conclusion: First-line THPyro was associated with a non-significant trend toward longer PFS and a significant 24-month RMST gain compared with THP in this retrospective matched cohort. An exploratory signal was observed among patients with baseline brain metastases, while diarrhea was more frequent and required proactive management.

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Cite

BibTeXRIS
BibTeX
@article{hujiahemaiti2026realworld,
  title = {{Real-world comparative outcomes of pyrotinib-based versus pertuzumab-based first-line therapy in HER2-Positive advanced breast cancer: a multicenter retrospective cohort study from Xinjiang, China}},
  author = {Yimuran Hujiahemaiti and Yinping Ge and Chao Zhang and Gulisire Abdoukerim and Jing Fei and Ruifeng Qi and Yan Li and Xiaoping Ma and Zhenhui Zhao and Li Li and Dan Liu and Bingyu Li and Xiner Zhang and Bing Zhao},
  journal = {Frontiers in Pharmacology},
  year = {2026},
  month = oct,
  doi = {10.3389/fphar.2026.1943895},
  url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1943895/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Real-world comparative outcomes of pyrotinib-based versus pertuzumab-based first-line therapy in HER2-Positive advanced breast cancer: a multicenter retrospective cohort study from Xinjiang, China
AU  - Yimuran Hujiahemaiti
AU  - Yinping Ge
AU  - Chao Zhang
AU  - Gulisire Abdoukerim
AU  - Jing Fei
AU  - Ruifeng Qi
AU  - Yan Li
AU  - Xiaoping Ma
AU  - Zhenhui Zhao
AU  - Li Li
AU  - Dan Liu
AU  - Bingyu Li
AU  - Xiner Zhang
AU  - Bing Zhao
PY  - 2026
DA  - 2026/10/15
JO  - Frontiers in Pharmacology
DO  - 10.3389/fphar.2026.1943895
UR  - https://www.frontiersin.org/articles/10.3389/fphar.2026.1943895/full
AB  - Background: Direct comparative evidence between taxane plus trastuzumab plus pyrotinib (THPyro) and taxane plus trastuzumab plus pertuzumab (THP) as first-line therapy for HER2-positive advanced breast cancer remains limited.  Methods: This multicenter retrospective real-world cohort study included 181 female patients in Xinjiang, China who initiated first-line THP or THPyro between 1 January 2020 and 30 September 2025. Propensity score matching generated 60 matched pairs. The primary endpoint was progression-free survival (PFS). Median follow-up in the matched cohort was 28.4 months.  Results: After matching, baseline characteristics were well balanced. THPyro showed numerically longer median PFS than THP (20.1 vs. 17.6 months; log-rank P = 0.086), and the stratified Cox model showed a non-significant trend toward reduced progression risk (hazard ratio, 0.478; 95% confidence interval, 0.216–1.061). Restricted mean survival time (RMST) analysis demonstrated a significant 24-month PFS gain with THPyro (absolute difference, 2.41 months; P = 0.007). Objective response and disease control rates were comparable. Brain metastasis status was the most prominent potential effect modifier, with an exploratory signal observed in patients with baseline brain metastases. THPyro was associated with more diarrhea, and higher albumin level and prophylactic loperamide use were associated with a lower observed risk of grade ≥2 diarrhea.  Conclusion: First-line THPyro was associated with a non-significant trend toward longer PFS and a significant 24-month RMST gain compared with THP in this retrospective matched cohort. An exploratory signal was observed among patients with baseline brain metastases, while diarrhea was more frequent and required proactive management.
SN  - 1663-9812
ER  -