Triple-negative breast cancer (TNBC) has a poor prognosis and limited treatment options. Although programmed death protein 1 (PD-1) inhibitor-based chemotherapy and its combination with antiangiogenic agents are increasingly used clinically, comparative effectiveness data are lacking. This real-world study compared chemoimmunotherapy (IC) versus chemoimmunotherapy plus antiangiogenic therapy (ICA) in advanced TNBC. Among 218 eligible patients, the ICA group (n = 119) showed a significantly higher disease control rate (DCR) than the IC group (n = 99) (85.7 vs. 73.7%, p = 0.009). Notable numerical improvements were observed in high-risk subgroups: in patients with ≥3 prior lines (n = 56), ICA improved DCR by 26.0% (81.6 vs. 55.6%, p = 0.039) and prolonged PFS by 2.9 months (5.3 vs. 2.4 months, p = 0.031). In those with brain metastases (n = 24), ICA increased DCR by 50.0% (83.3 vs. 33.3%, p = 0.017, posthoc power = 55.4%), with extended progression-free survival (PFS) (+4.0 months) and overall survival (OS) (+12.6 months). Early recurrence patients (disease-free interval (DFI) < 12 months, n = 54) showed a 28.6% higher DCR with ICA (78.6 vs. 50.0%, p = 0.024). This study highlights the potential of adding antiangiogenic therapy to chemoimmunotherapy, particularly for high-risk or refractory advanced TNBC patients, suggesting a strategy that may overcome programmed death ligand 1 (PD-L1)-related resistance and warrants prospective validation.
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