{"entity":{"id":"idea-til-guided-deescalation","kind":"idea","name":"TIL-based omission of chemotherapy in stage I TNBC","aka":[],"tldr":"Small triple-negative tumours packed with immune cells almost never come back. The idea is to skip chemotherapy for those patients.","summary":"Small triple-negative tumours packed with immune cells almost never come back, so this idea skips chemotherapy for stage I TNBC with high stromal TILs and treats with surgery and radiation alone. TILs mark a tumour already under immune control, and pooled cohorts such as ETNA, OPTimal and TIL-CHOICE suggest chemotherapy adds toxicity without measurable benefit in this group. A prospective single-arm trial with a non-inferiority boundary, central AI-assisted TIL scoring and ctDNA surveillance as a safety net would be needed before practice changes. The idea is being tested at scale, draws on histopathology and digital pathology AI, and is linked from the idea Payer-funded trials that omit surgery or radiotherapy in low-risk patients.","asOf":"2026-09-04","links":[{"label":"Leon-Ferre et al., Tumour-infiltrating lymphocytes in triple-negative breast cancer treated without chemotherapy (JAMA 2024)","url":"https://doi.org/10.1001/jama.2024.3056"}],"tags":[],"related":[],"cancers":["tnbc"],"sections":[],"technologies":["histopathology-ihc","digital-pathology-ai"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["tils"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-leon-ferre-tils-tnbc-no-chemotherapy-jama-2024"],"journals":[],"dependsOn":[],"notes":[],"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.","test":"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"},"route":"/ideas/idea-til-guided-deescalation/","neighbours":{"cancer":[{"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/"},{"id":"histopathology-ihc","kind":"technology","name":"Histopathology & immunohistochemistry","route":"/technologies/histopathology-ihc/"}],"term":[{"id":"tils","kind":"term","name":"Tumour-infiltrating lymphocytes (TILs)","route":"/terms/tils/"}],"paper":[{"id":"paper-leon-ferre-tils-tnbc-no-chemotherapy-jama-2024","kind":"paper","name":"Tumor-Infiltrating Lymphocytes in Triple-Negative Breast Cancer","route":"/key-papers/paper-leon-ferre-tils-tnbc-no-chemotherapy-jama-2024/"}],"idea":[{"id":"idea-fund-omission-deescalation-trials","kind":"idea","name":"Payer-funded trials that omit surgery or radiotherapy in low-risk patients","route":"/ideas/idea-fund-omission-deescalation-trials/"}]}}