Patient Considerations for TIL Therapy in Melanoma
Anuradha Krishnamurthy, MBBS, medical oncologist at Roswell Park Comprehensive Cancer Center, discusses ideal candidates for TIL therapy as well as what physicians should consider when referring patients with melanoma for this treatment.
For optimal outcomes with TIL (tumor-infiltrating lymphocytes) therapy, patient selection is key. Patients with a lower disease burden and normal LDH levels tend to respond better. This has led to discussions about using TIL therapy earlier in the treatment process, rather than primarily for heavily pre-treated individuals.
Patients with multiple comorbidities or those who are not physically fit are generally not good candidates for TIL therapy. The demanding nature of the treatment—which involves side effects from the TIL cells themselves, chemotherapy, and IL-2—can be significant. Therefore, these parameters are crucial in selecting patients who are most likely to achieve both effective and safe responses.
When considering referring patients for TIL therapy, providers should evaluate several key factors.
First, assess the patient's response to prior treatments, especially checkpoint inhibitors, and how well they tolerated them. Their performance status is also critical; are they functionally well, and what are their comorbidities? Fitness isn't just about a lack of illness; it's about their physical capacity—can they climb a flight of stairs without significant difficulty?
Additionally, consider the patient's tumor burden and LDH levels. While these factors won't necessarily prevent a referral, they are important starting points for discussion. Specialized TIL therapy centers can delve into these details during the patient evaluation process.
It's important to remember that TIL therapy is an intensive treatment. An elderly patient with multiple comorbidities who struggles with basic physical activities like climbing stairs might not be able to tolerate the therapy safely.
