• The WSG-TP-II trial investigated de-escalated neoadjuvant regimens in HR-positive, HER2-positive early breast cancer, comparing endocrine therapy plus trastuzumab/pertuzumab to paclitaxel plus trastuzumab/pertuzumab.
• Event-free survival at 5 years was 92.1% with endocrine therapy vs 94.8% with chemotherapy; overall survival was 100% vs 97.9%, indicating comparable long-term outcomes.
• The study suggests that endocrine therapy plus dual HER2 blockade can be a safe initial approach, reserving chemotherapy for patients not responding to de-escalated treatment.
• The trial demonstrated the feasibility of a 12-week chemotherapy-free de-escalation strategy without compromising survival in early-stage, hormone receptor-positive, HER2-positive breast cancer.