This study aims to evaluate the safety and effectiveness of JSKN016 in combination with different treatments for patients with HER2-negative breast cancer that cannot be removed by surgery or has spread to other parts of the body. The study includes four groups of patients based on treatment history and tumor characteristics. Each group will receive JSKN016 with chemotherapy or immunotherapy. The goal is to find out how well the treatment works and how safe it is.

This clinical study investigates the safety and efficacy of JSKN016 combined with various therapies for patients with advanced, inoperable, or metastatic HER2-negative breast cancer. The study includes four groups with different treatment regimens, targeting HR+HER2-negative breast cancer and triple-negative breast cancer (TNBC) with varying prior treatments. Participants will receive JSKN016 in combination with paclitaxel, capecitabine, eribulin, or pembrolizumab. The primary endpoint is the objective response rate (ORR) based on RECIST 1.1 criteria. The secondary endpoints include efficacy, safet, and other related outcomes.

Inclusion Criteria:

1. Capable of understanding and signing the informed consent form.

2. Aged ≥18 and ≤75 years, regardless of sex.

3. Histologically or cytologically confirmed inoperable locally advanced or metastatic HER2-negative breast cancer.

4. Hormone receptor-positive participants with progression/intolerance after standard endocrine therapy, or unsuitable for it.

5. Disease progression confirmed by radiological evidence post-systemic treatment.

6. Available archived or newly obtained tumor tissue/biopsy.

7. No prior systemic therapy for advanced disease, except for prior endocrine ± targeted therapy or CDK4/6 inhibitors.

8. Measurable non-CNS lesion per RECIST 1.1.

9. Expected survival ≥3 months.

10. ECOG performance status of 0 or 1.

11. Contraceptive use agreement for fertile participants.

12. Adequate organ function within 7 days of enrollment:

    • Bone marrow: ANC ≥1.5 × 10⁹/L, Hemoglobin ≥90 g/L, Platelets ≥100 × 10⁹/L.
    • Liver: Bilirubin ≤1.5 × ULN, ALT/AST ≤3 × ULN.
    • Renal: Creatinine ≤1.5 × ULN or Ccr ≥60 mL/min.
    • Coagulation: INR/PT ≤1.5 × ULN, APTT ≤1.5 × ULN.

13. LVEF ≥50%.

Exclusion Criteria:

1. CNS metastasis (except stable cases treated with radiation or surgery).
2. Unstable spinal cord compression or untreated history.
3. Recent live vaccine (except seasonal flu vaccines).
4. Recent anti-tumor treatment within 28 days or 5 half-lives (whichever is shorter).
5. Recent palliative therapy within 14 days.
6. Major surgery within 28 days or planned during the study.
7. Severe gastrointestinal issues or recent major GI bleeding.
8. Uncontrolled pleural/peritoneal effusions or cachexia.
9. Prior HER3/TROP2-targeted therapy or topoisomerase I inhibitors.
10. Other malignancies within 5 years (except certain skin or localized cancers).
11. Current interstitial lung disease or uncontrolled infections.
12. Severe hypercalcemia or uncontrolled cancer-related pain.
13. Autoimmune diseases, unless stable with treatment.
14. Uncontrolled comorbidities (e.g., active infections, cardiovascular issues).
15. Toxicities from previous treatments not resolved to CTCAE ≤1.
16. Recent steroid use or need for systemic immunosuppressive therapy.
17. Allergy to study drug components.
18. Pregnancy or breastfeeding.