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We evaluated how metabolic dysfunction affects treatment tolerability, pathologic complete response (pCR), and overall survival (OS) in routine care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of women with early-stage triple-negative breast cancer (TNBC) treated with the KEYNOTE-522 regimen at the Cleveland Clinic between January 1, 2020, and March 31, 2025. Metabolic syndrome was defined using a constellation of cardiometabolic risk factors consistent with criteria proposed by the American Heart Association and the National Heart, Lung, and Blood Institute, adapted to available real-world clinical data (BMI, HbA1c in place of fasting glucose, hypertension, chronic kidney disease, HDL\u2009&lt;\u200950\u00a0mg\/dL, triglycerides\u2009&gt;\u2009150\u00a0mg\/dL; \u22653 criteria). Data included demographics, tumor characteristics, treatment details, cardiometabolic comorbidities, CTCAE-graded adverse events, pathologic complete response (pCR), and overall survival (OS). Kaplan\u2013Meier methods estimated survival; logistic regression evaluated predictors of pCR; Cox proportional hazards models assessed OS. Median follow-up was 28.8 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 222 patients with early-stage TNBC treated with the KEYNOTE-522 regimen, 55 (24.8%) met criteria for metabolic syndrome. Patients with metabolic syndrome were older (median 65 vs. 55 years,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0004) and more frequently Black (43.6% vs. 18.0%). Cardiometabolic comorbidities were more prevalent, including obesity (85.5% vs. 35.9%), diabetes (72.7% vs. 7.8%), hypertension (69.1% vs. 24.6%), CKD (21.8% vs. 4.8%), low HDL (83.6% vs. 12.0%), and elevated triglycerides (58.2% vs. 6.0%) (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Dose reductions were more frequent among patients with metabolic syndrome (32.7% vs. 20.4%), with similar treatment discontinuation rates. pCR rates did not differ significantly (72.7% vs. 68.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.62), and no cardiometabolic factors independently predicted pCR. With median follow-up of 28.8 months, metabolic syndrome was associated with worse overall survival. Hypertension (HR 3.83, 95% CI 1.47\u20139.96,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) and diabetes (HR 3.07, 95% CI 1.33\u20137.08,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009) were independent predictors of mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cardiometabolic comorbidities, particularly hypertension, were associated with poorer survival and greater treatment intolerance despite preserved pCR. Systematic cardiometabolic assessment and proactive management should be integrated into TNBC care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10549-026-07995-5","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T06:37:22Z","timestamp":1781246242000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of cardiometabolic health on treatment outcomes in early-stage triple-negative breast cancer receiving chemoimmunotherapy"],"prefix":"10.1007","volume":"217","author":[{"given":"Jasmin","family":"Hundal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asfand","family":"Cheema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akram","family":"Abushamma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirti","family":"Arora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Fargo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maiti","family":"Baidehi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"7995_CR1","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3322\/caac.21820","volume":"74","author":"RL Siegel","year":"2024","unstructured":"Siegel RL, Giaquinto AN, Jemal A (2024) Cancer statistics, 2024. 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