However, direct comparative data on their efficacy and safety remain scarce.<h4>Objective</h4>To evaluate and compare the clinical outcomes of THPy and THP in the first-line treatment of HER2-positive MBC to guide clinical decision-making.<h4>Design</h4>Real-world, multicenter retrospective study conducted from 2020 to 2024.<h4>Setting</h4>Five large breast cancer centers in China.<h4>Participants</h4>A total of 145 patients with HER2-positive MBC were included before propensity score matching (PSM). Here, ERBB2 is linked to breast cancer.