{"entity":{"id":"paper-leon-ferre-tils-tnbc-no-chemotherapy-jama-2024","kind":"paper","name":"Tumor-Infiltrating Lymphocytes in Triple-Negative Breast Cancer","aka":[],"tldr":"A pooled study of 1,966 women with early triple-negative breast cancer treated with surgery and radiotherapy but no chemotherapy, in which those whose tumours were half or more immune cells had 94 percent five-year freedom from distant relapse in stage I disease against 78 percent for immune-poor tumours.","summary":"Leon-Ferre, Jonas, Salgado, Loi and colleagues pooled individual patient data from 13 centres in North America, Europe and Asia for 1,966 patients diagnosed with triple-negative breast cancer between 1979 and 2017 who received surgery with or without radiotherapy but no adjuvant or neoadjuvant chemotherapy (median age 56; 55 percent stage I). Median tumour-infiltrating lymphocyte level was 15 percent; 417 (21 percent) had 50 percent or more (median age 41) and 1,300 (66 percent) less than 30 percent. In stage I disease five-year distant recurrence-free survival was 94 percent (95 percent confidence interval 91 to 96) with lymphocytes of 50 percent or more versus 78 percent (75 to 80) below 30 percent, and five-year overall survival 95 versus 82 percent. At a median follow-up of 18 years each 10 percent increment in lymphocytes was independently associated with better invasive disease-free survival (hazard ratio 0.92), recurrence-free survival (0.90), distant recurrence-free survival (0.87) and overall survival (0.88).","asOf":"2026-09-24","links":[{"label":"JAMA 2024","url":"https://doi.org/10.1001/jama.2024.3056"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/38563834/"}],"tags":["tnbc-evidence"],"related":["paper-leon-ferre-jama"],"cancers":["tnbc","tnbc-early"],"sections":[],"technologies":["digital-pathology-ai"],"targets":[],"drugs":[],"companies":[],"institutions":["mayo-clinic"],"pathways":[],"terms":["tils","de-escalation","hazard-ratio"],"trials":[],"people":["loi-sherene","giuseppe-curigliano"],"bottlenecks":["b-toxicity-qol","b-biomarker-validation"],"keyPapers":[],"journals":["jama"],"dependsOn":[],"notes":[],"journal":"JAMA","year":2024,"doi":"10.1001/jama.2024.3056","pmid":"38563834","authors":"Leon-Ferre RA, Jonas SF, Salgado R, et al.","paperType":"observational","findings":["Stage I, lymphocytes 50 percent or more vs under 30 percent: five-year distant recurrence-free survival 94 vs 78 percent; five-year overall survival 95 vs 82 percent.","Each 10 percent increase in lymphocytes: hazard ratios 0.92 (invasive disease-free), 0.90 (recurrence-free), 0.87 (distant recurrence-free), 0.88 (overall survival), adjusted for age, size, nodes, grade and radiotherapy."],"whatItMeans":"The evidence behind the stage I de-escalation statement on the triple-negative page: an ordinary haematoxylin and eosin slide identifies a fifth of patients whose outcome without chemotherapy matches treated cohorts. A prospective trial of chemotherapy omission is the missing step.","caveats":["Retrospective; patients were untreated for historical or clinical reasons that may confound.","Lymphocyte scoring reproducibility between pathologists is imperfect; digital scoring is under evaluation."],"changedPractice":false,"participants":1966},"route":"/key-papers/paper-leon-ferre-tils-tnbc-no-chemotherapy-jama-2024/","neighbours":{"paper":[{"id":"paper-leon-ferre-jama","kind":"paper","name":"Tumor-Infiltrating Lymphocytes in Triple-Negative Breast Cancer","route":"/key-papers/paper-leon-ferre-jama/"}],"cancer":[{"id":"tnbc-early","kind":"cancer","name":"Early triple-negative breast cancer","route":"/cancers/tnbc-early/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"technology":[{"id":"digital-pathology-ai","kind":"technology","name":"Digital pathology & AI","route":"/technologies/digital-pathology-ai/"}],"institution":[{"id":"mayo-clinic","kind":"institution","name":"Mayo Clinic","route":"/institutions/mayo-clinic/"}],"term":[{"id":"de-escalation","kind":"term","name":"De-escalation, escalation and response-adapted therapy","route":"/terms/de-escalation/"},{"id":"hazard-ratio","kind":"term","name":"Hazard ratio (HR)","route":"/terms/hazard-ratio/"},{"id":"tils","kind":"term","name":"Tumour-infiltrating lymphocytes (TILs)","route":"/terms/tils/"}],"person":[{"id":"giuseppe-curigliano","kind":"person","name":"Giuseppe Curigliano","route":"/people/giuseppe-curigliano/"},{"id":"loi-sherene","kind":"person","name":"Sherene Loi","route":"/people/loi-sherene/"}],"bottleneck":[{"id":"b-biomarker-validation","kind":"bottleneck","name":"Biomarkers are not validated or standardised","route":"/bottlenecks/b-biomarker-validation/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"journal":[{"id":"jama","kind":"journal","name":"JAMA","route":"/journals/jama/"}],"roadmap":[{"id":"tnbc-roadmap","kind":"roadmap","name":"Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem","route":"/roadmaps/tnbc-roadmap/"}],"idea":[{"id":"idea-tnbc-de-escalation-for-exceptional-responders","kind":"idea","name":"Give exceptional responders less: pembrolizumab omission after complete response, anthracycline-free regimens and chemotherapy omission in lymphocyte-rich stage I disease","route":"/ideas/idea-tnbc-de-escalation-for-exceptional-responders/"}]}}