{
  "abstract": "Immune checkpoint inhibitors (ICIs) have improved outcomes in selected patients with metastatic triple-negative breast cancer (mTNBC), particularly those with high programed death-ligand 1 (PD-L1) expression. However, optimal dosing strategies balancing efficacy, toxicity, and cost remain unclear. We report the case of a 34-year-old woman with recurrent mTNBC and high PD-L1 expression (combined positive score, CPS ≥ 60; immunohistochemistry 22C3 pharmDx assay). She achieved durable disease control over 22 months (September 2024 to June 2026) using a combination of gemcitabine maintenance chemotherapy and low-dose intermittent nivolumab (40 mg fixed dose, administered 3-weekly). This de-escalated regimen was adopted due to early treatment toxicity and severe financial constraints. The patient achieved a confirmed partial response by RECIST v1.1 criteria (48% reduction in target lesion size), accompanied by manageable CTCAE Grade 2 hypothyroidism requiring oral levothyroxine replacement. This case illustrates that in biomarker-selected, PD-L1-high mTNBC, combination chemotherapy with low-intensity PD-1 blockade can maintain prolonged antitumor activity. These observations support the working hypothesis of a minimum effective immune dose, warranting prospective evaluation in resource-constrained clinical settings.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Clinical Oncology, Faculty of Medicine, Universiti Malaya, Jalan Universiti , ,",
    "Department of Clinical Oncology, Universiti Malaya Medical Centre, Jalan Profesor Diraja Ungku Aziz , ,"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Po Lin Ooi"
    },
    {
      "affs": [
        1
      ],
      "name": "Jamin Munchar Elias"
    },
    {
      "affs": [
        0
      ],
      "name": "Francis Yew Fu Tieng"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4vrcne2ny5q75.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1964934",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690642/?tool=EBI",
  "id": "4vrcne2ny5q75",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13690642",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2730|Cancer Immunotherapy and Biomarkers"
    ]
  ],
  "openalex": "W7221134882",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690642/pdf/?tool=EBI",
  "pmcid": "PMC13690642",
  "pmid": null,
  "published": "2026-10-09",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/4vrcne2ny5q75.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:59Z",
      "native_id": "PMC:PMC13690642",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13690642"
    },
    {
      "first_seen": "2026-10-30T12:20:13Z",
      "native_id": "10.3389/fonc.2026.1964934",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1964934/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Cancer Immunotherapy and Biomarkers",
      "subfield": "oncology"
    }
  ],
  "title": "Durable partial response with low-dose, intermittent nivolumab in combination with gemcitabine for high PD-L1 metastatic triple-negative breast cancer: a case report",
  "title_text": "Durable partial response with low-dose, intermittent nivolumab in combination with gemcitabine for high PD-L1 metastatic triple-negative breast cancer: a case report",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:13Z",
  "url": "https://research.draconitic.com/paper/4vrcne2ny5q75",
  "venue": "Frontiers in oncology",
  "versions": []
}