FMD and Neoadjuvant Chemo-immunotherapy in TNBC

Prior treatment

• Previous administration of any systemic anti-cancer therapy, including cytotoxic chemotherapy, targeted therapy, immunotherapy, or investigational treatment.
• Prior radiotherapy for breast cancer.
• Documented evidence (pathological or radiological) of distant metastasis prior to treatment initiation.
• Known allergy or hypersensitivity to any component of the investigational drugs or products.
• Unintentional weight loss ≥5% within the past 3 months, unless the patient's BMI \>22 kg/m² and weight loss at study entry is \<10%; or unintentional weight loss ≥10% within the past 3 months, unless the patient's BMI \>25 kg/m² and weight loss at study entry is \<15%. In either case, weight must have been stable for at least one month prior to enrollment.
• Severe infection within 4 weeks prior to enrollment, including but not limited to hospitalization for infectious complications, bacteremia, or severe pneumonia.
• Any unstable systemic disease, including: uncontrolled hypertension, unstable angina, angina pectoris with onset within the last 3 months, congestive heart failure, myocardial infarction (within 6 months prior to enrollment).

Other illness

• History of another malignancy within the five years preceding treatment initiation in this study, except for carcinoma in situ of the cervix, cured basal cell carcinoma, or urothelial tumors of the bladder (including Ta and Tis).
• Active autoimmune disease requiring systemic treatment (e.g., systemic lupus erythematosus, psoriasis, etc.).
• Eating disorders, including anorexia nervosa, bulimia nervosa, etc.
• Type 1 or Type 2 diabetes mellitus requiring medication (including but not limited to insulin or insulin secretagogues), with the exception of metformin.
• Severe arrhythmia requiring medication, or significant hepatic, renal, or metabolic disease.
• Known infection with Human Immunodeficiency Virus (HIV).
• Active, uncontrolled hepatitis B or hepatitis C.
• History of diagnosed neurological or psychiatric disorders, including epilepsy or dementia.
• Any other condition deemed by the investigator as unsuitable for participation.

Lab values

• Baseline fasting blood glucose ≤60 mg/dL (3.33 mmol/L).

Other

• Body Mass Index (BMI) \< 19 kg/m².
• Pregnant or lactating women.

• Written informed consent obtained from the patient or their legal representative.
• Good patient compliance, willing and able to adhere to the prescribed dietary intervention plan, visits, treatment schedule, laboratory tests, and other study procedures.
• Female, aged 18 to 70 years.
• ECOG performance status score of 0 to 1, with an expected survival of \>12 weeks.
• Female patients of childbearing potential must agree to use reliable methods of contraception from before trial entry, throughout the study, and for 8 weeks after the completion of the study.
• Patients with pathologically confirmed primary breast cancer, with a primary tumor ≥2 cm and regional lymph node status N0-N3 (AJCC Version 8); patients with positive lymph nodes may have a primary tumor of any size; no distant metastases (M0).
• Triple-negative or near-triple-negative subtype, defined as HR-negative or low expression (ER and/or PR positivity rate 1%-10%) and HER2-negative (IHC 0, 1+, or 2+ with FISH-negative).
• No prior history of any anti-tumor therapy, including chemotherapy, radiotherapy, and biological therapy.
• Hemoglobin ≥90 g/L (can be maintained or exceed this level via transfusion).
• Absolute neutrophil count ≥1.5 × 10E9/L.
• Platelet count ≥100 × 10E9/L.
• Total bilirubin ≤1.5 × upper limit of normal (ULN).
• Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 × ULN.
• Creatinine ≤1.5 × ULN.
• Fasting blood glucose \<250 mg/dL (13.89 mmol/L).
• Pregnancy must be ruled out for women of childbearing potential (aged 15-49).