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 ...