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This study aims to evaluate the effectiveness and toxicity of KN522 and to decouple the relative contributions of germline BRCA mutations (gBRCAmut) and pembrolizumab addition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of patients with stage II\u2013III triple negative breast cancer, treated at a single tertiary medical center with either KN522 or ACTC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 127 patients, four cohorts were evaluated: (1) KN522-gBRCAmut (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200926), (2) KN522-BRCA wildtype (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200953), (3) ACTC-gBRCAmut (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918), (4) ACTC-BRCA wildtype (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930). The KN522-gBRCAmut cohort achieved a remarkable pCR rate of 92.3%, compared to 60.4%, 55.6% and 36.7% in cohorts (2), (3) and (4) respectively. Multivariable analysis identified the KN522 protocol (OR 3.69, 95% CI 1.66\u20138.20;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and gBRCAmut status (OR 3.78, 95% CI 1.57\u20139.12;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) as independent predictors of pCR. Achieving pCR was associated with improved event-free and overall survival (OS) in univariate analyses. In multivariable models, however, pCR remained a significant independent predictor of OS only (HR\u2009=\u20090.15, 95% CI: 0.03\u20130.72,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018). KN522 was associated with higher hospitalization rates (40.5% vs. 14.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) and more neutropenic fever (NF) events (32.9% vs. 2.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), likely due to lower G-CSF prophylaxis during the AC part of the KN522 protocol (21.5% vs. 68.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this analysis, gBRCAmut carriers treated with KN522 achieved remarkably high pCR rates. The observed 40% hospitalizations, primarily due to NF, highlights the need for supportive care optimization, including G-CSF consideration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10549-026-08006-3","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T11:26:19Z","timestamp":1782127579000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and toxicity of neoadjuvant chemotherapy versus chemo-immunotherapy in triple-negative breast cancer patients with and without germline BRCA mutations"],"prefix":"10.1007","volume":"217","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3038-7472","authenticated-orcid":false,"given":"Tal","family":"Etan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lior","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yael","family":"Bar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8264-1308","authenticated-orcid":false,"given":"Yasmin","family":"Leshem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shir","family":"Lerner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Stepansky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Shiran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Sonnenblick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3396-8419","authenticated-orcid":false,"given":"Shlomit Strulov","family":"Shachar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"8006_CR1","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1038\/s41571-021-00565-2","volume":"19","author":"G Bianchini","year":"2022","unstructured":"Bianchini G, De Angelis C, Licata L et al (2022) Treatment landscape of triple-negative breast cancer \u2014 expanded options, evolving needs. 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