Editor’s Note: The 2025 Summer Breast Cancer Forum · Northern Salon was held in Qingdao, Shandong, from August 8–10. Upholding the spirit of “learning and innovation” and the tradition of “East and West, past and present, young and old,” the forum brought together experts to exchange views on academic frontiers. Topics included artificial intelligence in medicine, healthcare reform, and clinical hot spots such as neoadjuvant and adjuvant therapy in breast cancer. Through focused discussions and expert debates, the meeting aimed to optimize diagnostic and therapeutic strategies. On this occasion, Oncology Frontier invited Professor Xiaowei Qi of the Southwest Hospital, Army Medical University, to share his perspective on the debate over “optimal neoadjuvant strategies for HER2-positive breast cancer,” as well as his views on emerging advances in immunotherapy for triple-negative breast cancer (TNBC).TCbHP as the Preferred Neoadjuvant Strategy in HER2-Positive Breast Cancer
Oncology Frontier:In the debate on “optimal neoadjuvant strategies for HER2-positive breast cancer,” you supported the TCbHP regimen. Could you explain the rationale and supporting evidence for this choice?
Professor Xiaowei Qi:I support the TCbHP regimen as the preferred neoadjuvant strategy for HER2-positive early breast cancer. Neoadjuvant therapy plays a critical role in comprehensive management, with dual clinical value. First, it reduces tumor burden prior to surgery, increasing the feasibility of radical resection and improving breast-conserving or reconstructive surgery success rates. Second, treatment response provides valuable information on drug sensitivity, guiding postoperative adjuvant therapy decisions and ultimately improving patient outcomes.
My support for TCbHP rests on several considerations. Clinical evidence shows that this regimen significantly increases pathological complete response (pCR) rates and improves progression-free survival (PFS) and overall survival (OS) in HER2-positive early breast cancer. It also has a manageable safety profile with controllable adverse events. Furthermore, TCbHP is consistently recommended by leading guidelines, including the CSCO BC Guidelines, the CBCS Guidelines of the Chinese Anti-Cancer Association, and the NCCN Guidelines, providing robust evidence-based justification.
Research continues to explore novel strategies in neoadjuvant therapy—such as combinations of small- and large-molecule targeted agents, and ADCs with TKIs. Some promising results have emerged, such as the HELEN006 trial led by Professor Zhenzhen Liu of Henan Cancer Hospital and the neoCARHP study initiated by Professor Kun Wang of Guangdong Provincial People’s Hospital, both of which reported encouraging outcomes with platinum-based de-escalation regimens.
Nonetheless, these exploratory approaches have limitations. Many enrolled patients had relatively low tumor burden, leaving out a large proportion of real-world candidates for neoadjuvant therapy. Moreover, long-term survival data remain immature, and strategies for postoperative adjuvant intensification require further validation.
Overall, from the perspective of clinical feasibility, maturity of guideline endorsement, and evidence-based reliability, TCbHP offers comprehensive advantages in efficacy, safety, and supporting evidence, and should remain the preferred neoadjuvant therapy regimen for HER2-positive breast cancer at present.
Breakthrough Directions in TNBC Immunotherapy
Oncology Frontier:What topics at this year’s Summer Forum interested you most?
Professor Xiaowei Qi:The program of this year’s Summer Forum was very well designed, addressing hot topics, challenges, and real-world dilemmas in treating different breast cancer subtypes. The debate format allowed for in-depth exchanges. Personally, I was most interested in the dedicated session on TNBC immunotherapy. Professor Kun Wang provided a systematic overview of key issues in early-stage TNBC treatment, while Professor Jin Yang presented an excellent discussion on consensus and controversies in immunotherapy for advanced TNBC, as well as future directions. These discussions were highly insightful for clinical practice.
From my perspective, three major challenges remain in TNBC immunotherapy:
- Optimizing combination strategies. Whether pairing checkpoint inhibitors with anthracyclines, platinum agents, or ADCs, further studies are needed to identify the most effective regimens.
- Defining the right patient population. In the neoadjuvant setting, patients benefit regardless of PD-1 expression, but in advanced disease, only PD-1–positive patients derive benefit. Beyond PD-1, new biomarkers must be identified to better guide treatment selection.
- Managing immune-related adverse events. Developing specific monitoring tools to detect adverse events early could ensure safer, sustained application of immunotherapy.
These are the areas I believe deserve continued exploration to further improve outcomes for TNBC patients.
Professor Xiaowei Qi
Deputy Director / Assistant Director, Department of Breast and Thyroid SurgerySouthwest Hospital, Army Medical University
