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Neoadjuvant ARX788 plus pyrotinib versus trastuzumab, pertuzumab, docetaxel and carboplatin for HER2-positive breast cancer: a randomised phase 2b trial

Nan Niu, Jinqi Xue, Guanglei Chen, Fang Qiu, Qianshi Xu, Xinyu Zheng, Chao Liu, Yafei Zhao, Xi Gu, Yi Zhao, Hong Xu, Hao Zhang, Guijin He, Ke Li, Pengfei Li, Xiaoying Chen, Yong Li, Shuo Wang, Demiao Zhu, Tong Liu, Fei Xing, Yongqing Xu, Ye Han, Meiyue Tang, Mingxin Liu, Gege Jiao, Xiaofan Jiang, Tony Yuen, Zheng Pang () and Caigang Liu ()
Additional contact information
Nan Niu: Shengjing Hospital of China Medical University
Jinqi Xue: Shengjing Hospital of China Medical University
Guanglei Chen: Shengjing Hospital of China Medical University
Fang Qiu: Shengjing Hospital of China Medical University
Qianshi Xu: Shengjing Hospital of China Medical University
Xinyu Zheng: the First Affiliated Hospital of China Medical University
Chao Liu: Shengjing Hospital of China Medical University
Yafei Zhao: Shengjing Hospital of China Medical University
Xi Gu: Shengjing Hospital of China Medical University
Yi Zhao: Shengjing Hospital of China Medical University
Hong Xu: Liaoning Cancer Hospital and Institute
Hao Zhang: Liaoning Cancer Hospital and Institute
Guijin He: Shengjing Hospital of China Medical University
Ke Li: Anshan Cancer Hospital
Pengfei Li: Yanan People’s Hospital
Xiaoying Chen: Liaohe Oilfield General Hospital
Yong Li: Benxi Central Hospital
Shuo Wang: the First Affiliated Hospital of China Medical University
Demiao Zhu: the First Affiliated Hospital of Jinzhou Medical University
Tong Liu: Cancer Hospital of Harbin Medical University
Fei Xing: Shengjing Hospital of China Medical University
Yongqing Xu: Shengjing Hospital of China Medical University
Ye Han: Shengjing Hospital of China Medical University
Meiyue Tang: Shengjing Hospital of China Medical University
Mingxin Liu: Shengjing Hospital of China Medical University
Gege Jiao: Shengjing Hospital of China Medical University
Xiaofan Jiang: Shengjing Hospital of China Medical University
Tony Yuen: Icahn School of Medicine at Mount Sinai
Zheng Pang: Ltd
Caigang Liu: Shengjing Hospital of China Medical University

Nature Communications, 2025, vol. 16, issue 1, 1-9

Abstract: Abstract Antibody-drug conjugates (ADCs) and tyrosine kinase inhibitors (TKIs) are widely used for HER2-positive metastatic breast cancer, but their efficacy in the neoadjuvant setting remains under investigation. The MUKDEN 06 trial (NCT05426486), a multicentre, randomised, phase 2b study, compared ARX788 (anti-HER2 ADC) plus pyrotinib (TKI) with the standard neoadjuvant regimen of docetaxel, carboplatin, trastuzumab, and pertuzumab (TCbHP) in female patients with early or locally advanced HER2-positive breast cancer. The primary endpoint was the pathological complete response (pCR, ypT0/is, ypN0) rate, analyzed in the intention-to-treat population. pCR was achieved in 70.6% (48/68) of patients receiving ARX788 plus pyrotinib, compared to 51.5% (35/68) in the TCbHP group, with a significant absolute difference of 19.1% (95% CI, 2.7–34.6; p = 0.023). No treatment-related deaths occurred. The most common grade 3–4 adverse events were diarrhea and hepatic dysfunction in the ARX788 plus pyrotinib group, and fatigue, nausea and anorexia in the TCbHP group. Interstitial lung disease (ILD)/pneumonitis and ocular events were observed with ARX788 plus pyrotinib, indicating a distinct safety profile. These findings offer clinical insights into the potential of dual HER2-targeted blockade with an ADC and TKI as an optional neoadjuvant strategy for patients with early or locally advanced HER2-positive breast cancer.

Date: 2025
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DOI: 10.1038/s41467-025-61213-2

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