Fig. 2

Using the TIL infiltrate and response to frontline treatments to guide patient management decisions. The presence of tumor-infiltrating lymphocytes (TILs) and response to neoadjuvant chemotherapy (NAC) may be used to guide decisions on second line treatments. Patients with high TILs and exhibiting pathological complete responses to NAC (far left) have an excellent prognosis and may not require further intervention other than standard of care. Patients with high TILs at diagnosis but no pathological complete response, or patients with low TILs at diagnosis but high TILs post-NAC, may benefit from immunotherapies, such as checkpoint inhibition (PD-1 blockade), or immune agonists (e.g., 4-1BB). However, patients with little TIL infiltrate either pre-NAC or post-NAC (far right) require additional or different treatment strategies to induce an immune response, such as adoptive cellular therapy or vaccination strategies. Targeted inhibitors (e.g., MEK inhibitors) should be considered for all patient groups where appropriate, but the impact of targeted inhibitors on the immune response should be a therapeutic consideration. This figure was made exclusively for this manuscript. DC dendritic cells, FACS fluorescence-activated cell sorting, H&E hematoxylin and eosin staining