ideasIdea

TIL-based omission of chemotherapy in stage I TNBC

Small triple-negative tumours packed with immune cells almost never come back. The idea is to skip chemotherapy for those patients.

Pooled cohorts (ETNA, OPTimal, TIL-CHOICE) show >90% 5-year RFS for stage I TNBC with stromal TILs ≥50% without systemic therapy. A prospective trial is needed before practice changes.

Confidence

55%–80%likelyOnCo editors (initial estimate), 2026-09-07 · Retrospective cohorts are consistent; prospective single-arm trials are running.

Hypothesis

Stage I TNBC with sTILs ≥50% (or ≥30% with pT1a-b) managed with surgery and radiation alone has 5-year iDFS non-inferior to chemotherapy.

Rationale

TILs mark a tumour already under immune control; chemotherapy adds toxicity without measurable benefit in this group.

What would test it

Run a single-arm prospective trial with a non-inferiority boundary (e.g., 5-year iDFS >90%), central AI-assisted TIL scoring, and ctDNA surveillance as a safety net.

Maturity

being tested at scale

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TIL-based omission of chemotherapy in stage I TNBC

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