Exploring the impacts of docetaxel and paclitaxel based neoadjuvant therapies on early postoperative complications in HER2-positive breast cancer patients

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BACKGROUND: HER2-positive breast cancer accounts for 15-20% of all breast cancer cases. Anti-HER2-based neoadjuvant therapy combined with taxanes, particularly docetaxel and paclitaxel, constitutes the standard treatment approach. Although these regimens are widely used, most studies have focused on systemic adverse effects, with limited data addressing their impact on postoperative surgical complications. This study aimed to evaluate the association between docetaxel- and paclitaxel-based neoadjuvant regimens and early wound complications in HER2-positive breast cancer patients. METHOD: We retrospectively analyzed 139 patients with HER2-positive breast cancer who underwent breast-conserving surgery following neoadjuvant therapy at Ankara Etlik City Hospital between October 2022 and January 2025. Patients were grouped according to the taxane received (docetaxel, n = 95; paclitaxel, n = 44). Demographic, clinicopathologic characteristics, and early postoperative wound complications were compared. Major complications were defined as major wound dehiscence and skin necrosis. Associations between variables and major complications were evaluated using univariate analysis. RESULTS: Major complications were significantly more frequent in the docetaxel group compared to the paclitaxel group (9.5% vs. 0%, p = 0.022), while no significant difference was observed in minor complications (p = 0.704). In subgroup analysis excluding patients who underwent axillary lymph node dissection, this association remained significant (11.1% vs. 0%, p = 0.034). CONCLUSIONS: Docetaxel-based neoadjuvant therapy was associated with a higher rate of major postoperative wound complications compared with paclitaxel-based regimens in patients with HER2-positive breast cancer. This association persisted after excluding patients who underwent axillary lymph node dissection. These findings should be interpreted with caution due to the retrospective design and limited number of events.

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