Effect of immunotherapy or anti-angiogenesis therapy combined with chemotherapy for advanced triple-negative breast cancer: A real-world retrospective study

•ICI-chemo demonstrated better clinical survival benefit than anti-angio-chemo for the first-line treatment of advanced TNBC.•ICI-chemo/anti-angio-chemo is a promising therapeutic option for the second line or later therapy of advanced TNBC.•No difference between the ICI-chemo and the anti-angio-chemo group in terms of the incidence of grade 3–4 toxicity.•ICI-chemo showed trends of improved PFS in CPS ≥10 subgroups. Immune checkpoint inhibitors combined with chemotherapy (ICI-chemo) and anti-angiogenesis therapy combined with chemotherapy (anti-angio-chemo) have demonstrated superiority over traditional chemotherapy in patients with advanced triple-negative breast cancer (TNBC). However, due to the absence of a direct comparison between ICI-chemo and anti-angio-chemo, it remains unclear which treatment is superior. This study aimed to investigate the efficacy and safety of ICI-chemo or anti-angio-chemo for advanced TNBC at Sun Yat-sen University Cancer Center. A retrospective analysis was conducted on the medical records of advanced TNBC patients who received ICI-chemo or anti-angio-chemo treatment between January 2017 and March 2023. Survival outcomes and safety profiles were evaluated. A total of 178 patients were enrolled, including 101 who received ICI-chemo and 77 who received anti-angio-chemo. The median follow-up time was 19.93 months [95 % confidence interval (CI): 17.05–22.81]. There was no significant difference in patient outcomes, including progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and disease control rate (DCR) between the two treatment regimens in the overall population. However, ICI-chemo demonstrated clinical survival benefits, with significant improvements in PFS and OS [hazard ratio (HR) = 0. 546, P = 0.048; HR = 0.313, P = 0.032] in patients receiving first-line treatment. The median PFS (mPFS) for the ICI-chemo and anti-angio-chemo cohorts was 9.37 and 6.03 months, respectively. Univariate and multivariate analyses showed that ICI-chemo independently achieved favorable PFS. No statistically significant difference was observed in PFS or OS between patients who received second-line or later ICI-chemo or anti-angio-chemo. The mPFS was 4.83 and 5.03 months, respectively. The toxicity profiles of adverse events were similar across two cohorts. Among patients with advanced TNBC, ICI-chemo is associated with potentially longer survival compared to anti-angio-chemo as first-line treatment. Given thei