TIL Therapy: A New Era for Advanced Melanoma Treatment

Anuradha Krishnamurthy, MBBS, provides backgrounds on TILs and discusses their critical role in the advanced melanoma treatment landscape.

Therapy using tumor-infiltrating lymphocytes (TIL) has been around for a long time, with the National Institutes of Health (NIH) conducting research in this area for over 30 years. However, it has only recently received approval for treating melanoma, especially advanced or metastatic forms.

TIL therapy's approval stems from promising clinical trials. An initial phase 2 trial for advanced melanoma showed a 31% objective response rate in patients. This led to a follow-up phase 3 trial that further demonstrated the therapy's benefits. In this trial, TIL therapy not only improved objective response rates but also extended median overall survival and, crucially, provided sustained responses for prolonged periods.

TIL therapy offers a much-needed treatment option for a specific group of melanoma patients: those who have progressed after treatment with checkpoint inhibitors. While checkpoint inhibitors revolutionized melanoma treatment, a significant number of patients either don't respond initially or eventually progress after exposure to these drugs. Until recently, there weren't many effective options for this group. TIL therapy, specifically lifileucel (Amtagvi), fills this gap.

Administering TIL therapy is complex and requires specialized facilities. Only centers with the necessary infrastructure can offer it, as it involves hospital admission for patients, administration of IL-2, and managing complications from TIL therapy itself and IL-2.

Given these complexities, not all centers currently offer TIL therapy, and not all patients are suitable candidates. Careful patient selection is crucial to ensure good and safe outcomes.