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