Durable partial response with low-dose, intermittent nivolumab in combination with gemcitabine for high PD-L1 metastatic triple-negative breast cancer: a case report
- 1Department of Clinical Oncology, Faculty of Medicine, Universiti Malaya, Jalan Universiti , ,
- 2Department of Clinical Oncology, Universiti Malaya Medical Centre, Jalan Profesor Diraja Ungku Aziz , ,
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.
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BibTeX
@article{ooi2026durable,
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}},
author = {Po Lin Ooi and Jamin Munchar Elias and Francis Yew Fu Tieng},
journal = {Frontiers in oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1964934},
url = {https://europepmc.org/article/PMC/PMC13690642},
note = {CC BY},
}
RIS
TY - JOUR
TI - Durable partial response with low-dose, intermittent nivolumab in combination with gemcitabine for high PD-L1 metastatic triple-negative breast cancer: a case report
AU - Po Lin Ooi
AU - Jamin Munchar Elias
AU - Francis Yew Fu Tieng
PY - 2026
DA - 2026/10/09
JO - Frontiers in oncology
DO - 10.3389/fonc.2026.1964934
UR - https://europepmc.org/article/PMC/PMC13690642
AB - 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.
SN - 2234-943X
ER -