TIL-based omission of chemotherapy in stage I TNBC

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.