# Immunomodulatory triple-negative breast cancer (IM)

Source: https://onco.cc/cancers/tnbc-immunomodulatory/  
OnCo record `tnbc-immunomodulatory` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Immunomodulatory triple-negative breast cancers are the ones packed with immune cells. The 2016 re-analysis showed the signature comes from those lymphocytes rather than the tumour, so today the same idea is captured by counting tumour-infiltrating lymphocytes on the biopsy, which predicts a better outcome and is used to test whether some small tumours need less treatment.

## Summary

The immunomodulatory (IM) subtype was enriched for immune cell processes, cytokine and antigen-processing pathways and immune signal transduction (Lehmann 2011). Laser-capture microdissection then showed those transcripts were contributed by infiltrating lymphocytes, so IM was removed as a tumour-intrinsic subtype in the four-way refinement (Lehmann 2016). Burstein's basal-like immune-activated (BLIA) subtype, defined by Stat signalling and cytokine expression, had the best disease-free and disease-specific survival of the four Burstein subtypes, and basal-like immunosuppressed (BLIS), marked by the immunosuppressing molecule VTCN1, the worst (Burstein 2015). In clinical practice the equivalent measurement is stromal tumour-infiltrating lymphocytes, and the parent page's biomarker and stage I rows carry the de-escalation cohorts; PD-L1 expression on immune cells is the treatment-selecting marker in metastatic disease (the glossary term for CPS 10 has the figures).

A research classification by gene expression (Lehmann 2011, refined 2016), not a test the NHS runs; treatment follows the triple-negative rows on the parent page.

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: IM subtype; Immunomodulatory TNBC; Basal-like immune-activated (BLIA, Burstein)
- Tags: breast; tnbc; subtype-page
- Group: breast
- Burden: One of the six 2011 Lehmann subtypes, traced in 2016 to infiltrating lymphocytes; its clinical counterpart, high stromal tumour-infiltrating lymphocytes, is scored on routine slides.
- Subtypes: Basal-like immune-activated (BLIA), best prognosis of the Burstein subtypes; Basal-like immunosuppressed (BLIS), worst prognosis
- Biomarkers: Stromal tumour-infiltrating lymphocytes on the biopsy (prognostic; de-escalation trials); PD-L1 combined positive score (metastatic pembrolizumab eligibility at 10 or more); Immune gene expression (research)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/tnbc-immunomodulatory/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/tnbc-immunomodulatory/#overview
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/tnbc-immunomodulatory/#what-it-is [2 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/tnbc-immunomodulatory/#finding-it [3 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/tnbc-immunomodulatory/#treating-it [1 setting]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/tnbc-immunomodulatory/#evidence [1 trial]
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/tnbc-immunomodulatory/#science [2 targets, 1 pathway]
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/tnbc-immunomodulatory/where-you-are/
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/tnbc-immunomodulatory/#living-with-it [9 questions, 3 red cards]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/tnbc-immunomodulatory/coming/ [1 medicine]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/tnbc-immunomodulatory/data/ [10 connected records]

## Standard of care

- Metastatic, PD-L1 CPS 10 or more: Pembrolizumab with chemotherapy (KEYNOTE-355; NICE TA801) or with sacituzumab govitecan (ASCENT-04); the rows on the parent page. ([KEYNOTE-355](https://onco.cc/trials/keynote-355/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Combined positive score (CPS)](https://onco.cc/terms/cps/), [PD-L1 combined positive score 10 in triple-negative breast cancer](https://onco.cc/terms/pd-l1-cps-10-tnbc/))

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Tumor-infiltrating_lymphocytes
- Lehmann, J Clin Invest 2011: identification of human triple-negative breast cancer subtypes (BL1, BL2, IM, M, MSL, LAR): https://doi.org/10.1172/jci45014
- Lehmann, PLoS One 2016: refinement of triple-negative breast cancer molecular subtypes to four (TNBCtype-4): https://doi.org/10.1371/journal.pone.0157368
- Burstein, Clin Cancer Res 2015: four triple-negative subtypes (LAR, MES, BLIS, BLIA) with distinct prognoses: https://doi.org/10.1158/1078-0432.ccr-14-0432
- Cortes, N Engl J Med 2022: KEYNOTE-355 overall survival by PD-L1 combined positive score: https://doi.org/10.1056/nejmoa2202809

## Connected records

- cancers: [Basal-like 1 triple-negative breast cancer (BL1)](https://onco.cc/cancers/tnbc-basal-like-1/), [Carcinoma with medullary pattern (medullary breast cancer)](https://onco.cc/cancers/medullary-pattern-breast-carcinoma/), [Mesenchymal stem-like triple-negative breast cancer (MSL)](https://onco.cc/cancers/tnbc-mesenchymal-stem-like/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- targets: [PD-1](https://onco.cc/targets/pd1/), [PD-L1](https://onco.cc/targets/pdl1/)
- pathways: [PD-1 / PD-L1 immune checkpoint & T-cell activation](https://onco.cc/pathways/pd1-checkpoint/)
- terms: [Combined positive score (CPS)](https://onco.cc/terms/cps/), [PD-L1 combined positive score 10 in triple-negative breast cancer](https://onco.cc/terms/pd-l1-cps-10-tnbc/), [Tumour-infiltrating lymphocytes (TILs)](https://onco.cc/terms/tils/)
- trials: [KEYNOTE-355](https://onco.cc/trials/keynote-355/)
- drugs: [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)

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JSON: https://onco.cc/api/v1/entities/tnbc-immunomodulatory.json