Background: Docetaxel, carboplatin and trastuzumab, with or without pertuzumab (TCH(P)), is increasingly used for (neo) adjuvant treatment of HER2-positive early breast cancer. However, its associated febrile neutropenia (FN) risk is unclear: pivotal studies reported FN risks <10%, but in clinical practice a high FN rate (>20%) was observed. This systematic review and meta-analysis determine the FN risk associated with TCH(P) and the effect of primary prophylactic granulocyte colony-stimulating factor (PP G-CSF).