Adjuvant Intensification for LAR

Exclusion Criteria

• •Patients who meet \*\*any\*\* of the following criteria will be excluded from this study:
• •1. Bilateral breast cancer.
• •2. Metastatic disease at any site.
• •3. Patients with cT \> 2 cm or positive lymph nodes \*\*and\*\* carrying pathogenic/likely pathogenic germline BRCA1/2 mutations.
• •4. History of clinically significant or uncontrolled cardiac disease, including congestive heart failure, angina, myocardial infarction within the past 6 months, or ventricular arrhythmia.
• •5. History of clinically significant pulmonary disease, including but not limited to interstitial pneumonia, pneumonia, pulmonary fibrosis, and radiation pneumonitis (except for asymptomatic radiation changes not requiring intervention); or suspected such disease based on screening examinations.
• •6. History of other malignancies within the past 5 years, excluding cured carcinoma in situ of the cervix, basal cell carcinoma of the skin, or squamous cell carcinoma of the skin.
• •7. Pregnant or lactating women; women of childbearing potential who cannot practice effective contraception.
• •8. Patients concurrently participating in other clinical trials.
• •9. Patients with a history of hypersensitivity or known allergy to any component of the study drugs; or patients with a history of allergy to other monoclonal antibodies.
• •10. Severe or uncontrolled infection.
• •11. Hypertension that cannot be adequately controlled with antihypertensive medication (systolic blood pressure \> 140 mmHg, diastolic blood pressure \> 90 mmHg).
• •12. History of gastrointestinal bleeding within the past 6 months, or clear tendency for gastrointestinal bleeding, such as esophageal varices at risk of bleeding, locally active ulcerative lesions, or fecal occult blood ≥ (++). Patients with fecal occult blood (+) must undergo gastroscopy for further evaluation.
• •13. Known active HBV or HCV infection (HBV-DNA ≥ 500 IU/mL), or chronic infection with abnormal liver function.
• •14. Urinalysis showing urine protein ≥ ++, or 24-hour urine protein quantification \> 1.0 g.
• •15. History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 28 days prior to study enrollment.
• •16. History of drug abuse (psychoactive substances) with inability to abstain, or history of psychiatric disorders.
• •17. Patients deemed unsuitable for participation by the investigator's judgment.