{"entity":{"id":"tnbc-immunomodulatory","kind":"cancer","name":"Immunomodulatory triple-negative breast cancer (IM)","aka":["IM subtype","Immunomodulatory TNBC","Basal-like immune-activated (BLIA, Burstein)"],"tldr":"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).\n\nA 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.","asOf":"2026-09-24","wikipedia":"https://en.wikipedia.org/wiki/Tumor-infiltrating_lymphocytes","links":[{"label":"Lehmann, J Clin Invest 2011: identification of human triple-negative breast cancer subtypes (BL1, BL2, IM, M, MSL, LAR)","url":"https://doi.org/10.1172/jci45014"},{"label":"Lehmann, PLoS One 2016: refinement of triple-negative breast cancer molecular subtypes to four (TNBCtype-4)","url":"https://doi.org/10.1371/journal.pone.0157368"},{"label":"Burstein, Clin Cancer Res 2015: four triple-negative subtypes (LAR, MES, BLIS, BLIA) with distinct prognoses","url":"https://doi.org/10.1158/1078-0432.ccr-14-0432"},{"label":"Cortes, N Engl J Med 2022: KEYNOTE-355 overall survival by PD-L1 combined positive score","url":"https://doi.org/10.1056/nejmoa2202809"}],"tags":["breast","tnbc","subtype-page"],"related":["tnbc","tnbc-mesenchymal-stem-like","tnbc-basal-like-1"],"cancers":[],"sections":[],"technologies":[],"targets":["pdl1","pd1"],"drugs":[],"companies":[],"institutions":[],"pathways":["pd1-checkpoint"],"terms":["tils","pd-l1-cps-10-tnbc","cps"],"trials":["keynote-355"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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)"],"standardOfCare":[{"setting":"Metastatic, PD-L1 CPS 10 or more","approach":"Pembrolizumab with chemotherapy (KEYNOTE-355; NICE TA801) or with sacituzumab govitecan (ASCENT-04); the rows on the parent page.","refs":["keynote-355","pembrolizumab","cps","pd-l1-cps-10-tnbc"]}],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"tnbc"},"route":"/cancers/tnbc-immunomodulatory/","neighbours":{"cancer":[{"id":"tnbc-basal-like-1","kind":"cancer","name":"Basal-like 1 triple-negative breast cancer (BL1)","route":"/cancers/tnbc-basal-like-1/"},{"id":"medullary-pattern-breast-carcinoma","kind":"cancer","name":"Carcinoma with medullary pattern (medullary breast cancer)","route":"/cancers/medullary-pattern-breast-carcinoma/"},{"id":"tnbc-mesenchymal-stem-like","kind":"cancer","name":"Mesenchymal stem-like triple-negative breast cancer (MSL)","route":"/cancers/tnbc-mesenchymal-stem-like/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"target":[{"id":"pd1","kind":"target","name":"PD-1","route":"/targets/pd1/"},{"id":"pdl1","kind":"target","name":"PD-L1","route":"/targets/pdl1/"}],"pathway":[{"id":"pd1-checkpoint","kind":"pathway","name":"PD-1 / PD-L1 immune checkpoint & T-cell activation","route":"/pathways/pd1-checkpoint/"}],"term":[{"id":"cps","kind":"term","name":"Combined positive score (CPS)","route":"/terms/cps/"},{"id":"pd-l1-cps-10-tnbc","kind":"term","name":"PD-L1 combined positive score 10 in triple-negative breast cancer","route":"/terms/pd-l1-cps-10-tnbc/"},{"id":"tils","kind":"term","name":"Tumour-infiltrating lymphocytes (TILs)","route":"/terms/tils/"}],"trial":[{"id":"keynote-355","kind":"trial","name":"KEYNOTE-355","route":"/trials/keynote-355/"}],"drug":[{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"}]}}