What does all these tmb - low , msi - stable and pdl1 negative means for a stage 4 breast cancer? can patient survive without immunotherapy ad it cost v high?
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TMB low , MSI stable and PDL1 negative means that single agent immunotherapy will not be effective. Combination with chemotherapy can be tried in later lines; but benefit may not be great. Whether patient will do well will depend on the stage of the disease and how extensive is the metastases that patient has. These tests have nothing to do with survival, it is only to predict response to immunotherapy
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