# TRAIN-2: neoadjuvant chemotherapy with or without anthracyclines alongside dual HER2 blockade

Source: https://onco.cc/key-papers/paper-train-2-lancet-oncol-2018/  
OnCo record `paper-train-2-lancet-oncol-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Leaving out anthracyclines from neoadjuvant chemotherapy made no difference to how many HER2-positive breast cancers disappeared completely when trastuzumab and pertuzumab were given, so the heart-toxic drugs can be dropped.

## Summary

Phase 3 trial of 438 patients with stage II to III HER2-positive breast cancer randomised to nine cycles of carboplatin-paclitaxel with trastuzumab and pertuzumab, with or without three initial cycles of an anthracycline-containing regimen.

Pathological complete response was 67 percent with anthracyclines and 68 percent without; three-year event-free survival was similar, while febrile neutropenia and cardiac events were more common with anthracyclines.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet Oncology
- Year: 2018
- DOI: 10.1016/S1470-2045(18)30570-9
- Authors: van Ramshorst MS, van der Voort A, van Werkhoven ED, et al.
- Findings: Pathological complete response 67 percent with vs 68 percent without anthracyclines.; Three-year event-free survival 92.7 percent vs 93.6 percent.
- What it means: Anthracycline-free carboplatin-taxane chemotherapy with dual HER2 blockade is a standard neoadjuvant regimen, sparing patients cardiac risk without losing efficacy.
- Caveats: Not powered for long-term survival differences.; Both arms used nine cycles of chemotherapy, longer than some current regimens.

## Sources

- Lancet Oncol 2018: https://doi.org/10.1016/S1470-2045(18)30570-9
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30413379/

## Connected records

- cancers: [Early HER2-positive breast cancer](https://onco.cc/cancers/her2-positive-early-breast-cancer/)
- trials: [TRAIN-2](https://onco.cc/trials/train-2/)
- journals: [The Lancet Oncology](https://onco.cc/journals/lancet-oncology/)

---
JSON: https://onco.cc/api/v1/entities/paper-train-2-lancet-oncol-2018.json