Durable partial response with low-dose, intermittent nivolumab in combination with gemcitabine for high PD-L1 metastatic triple-negative breast cancer: a case report.

Authors

Po Lin Ooi, Jamin Munchar Elias, Francis Yew Fu Tieng

Published in

Frontiers in oncology. Volume 16. Pages 1964934. Epub Oct 09, 2026.

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.

PMID:
42920527
Bibliographic data and abstract were imported from PubMed on 24 Oct 2026.

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