Tumor mutational burden (TMB) is a relatively new gene-based biomarker emerging as a guide for immunotherapy. Here, James Spicer, FCRP, PhD, MRCP, MBBS, of the Guy’s and St Thomas’ NHS Foundation Trust, London, UK, provides an insight into the uses and potential applications of TMB, basing the theme of his discussion on emerging data from a press release on the CheckMate-227 study. Professor Spicer also shows interest in the prospects of blood TMB, a development from tumor DNA-based TMB, yet highlights the limited data available and the need for further questions to be answered with respect to this biomarker.