Efficacy and pharmacoeconomic evaluation of subcutaneous and intravenous dual-target therapy combined with albumin-bound paclitaxel as neoadjuvant therapy for human epidermal growth factor receptor 2-positive early breast cancer

Fu Xiaoyan; Zhang Chun; Li Chen; Wang Qinqin; Chu Futao; Yu Xue; Meng Xiangzhi

doi:10.3760/j.issn.1673-4777.2026.07.012

Abstract：Objective To evaluate the clinical outcomes and real-world pharmacoeconomic value of subcutaneous(SC)versus intravenous(Ⅳ)administration in the de-escalated dual-target non-anthracycline regimen combined with albumin-bound paclitaxel(nab-PHP regimen)for human epidermal growth factor receptor 2(HER2)-positive breast cancer.Methods A total of 72 female patients with HER2-positive early invasive breast cancer scheduled for neoadjuvant therapy admitted to Peking University International Hospital from January 2024 to December 2025 were retrospectively enrolled and divided into SC group(37 cases)and Ⅳ group(intravenous control group,35 cases)according to administration route.Inverse probability of treatment weighting(IPTW)was applied to balance baseline covariates between groups.The primary clinical endpoint was overall pathological complete response rate,with a prespecified non-inferiority margin of-10％.The primary economic endpoint was total direct medical cost.Time-driven activity-based costing(TDABC)was adopted to accurately calculate medical staff labor and time costs,and cost-minimization analysis was conducted.Results After IPTW weighting,baseline characteristics were well balanced between the two groups(standardized mean difference＜0.1).For clinical efficacy,the absolute difference in overall pathological complete response rate between the SC group and Ⅳ group was merely 0.6％(95％confidence interval:-4.8％-6.0％),which verified the absolute non-inferiority of subcutaneous administration(Pnon-inf＜0.001).In terms of safety,the incidence of all-grade infusion-related reactions in the SC group was lower than that in the Ⅳ group[2.7％(1/37)vs 17.1％(6/35)](P＜0.05).Medical resource accounting based on TDABC showed that per-cycle chair-side administration time,pharmacy preparation time in intravenous admixture service,drug delivery and monitoring time were all shorter in the SC group(all P＜0.001).Comprehensive statistical results demonstrated that the total cost for completing the full course of neoadjuvant therapy in the SC group was lower than that in the Ⅳ group(P＜0.001).Conclusions For de-escalated neoadjuvant therapy of HER2-positive early breast cancer,the SC-nab-PHP regimen is non-inferior to the conventional intravenous regimen in pathological complete response rate,with improved safety and reduced medical costs.