Would you consider using IO alone for lung cancer patients with PD-L1 <1%  but who have high TMB?

The brief answer here is a resounding no. A more extended version might include a statement that this would be a case of not seeing the forest for the trees.

And the tree here is the FDA approval of pembrolizumab in a tissue-agnostic fashion for patients with advanced TMB >10 mutations/Mbase- likely ...

The CheckMate 227 trial showed that patients with a PD-L1 expression of <1% had a better OS with the combination of nivolumab and ipilimumab when compared to chemotherapy, regardless of TMB status. In an unplanned subgroup analysis, in patients with PD-L1 <1%, patients with a TMB >/= 10 muts/mB seem...