TIL Therapy for Melanoma: Magic Bullet? Or?

TIL Therapy also known as the ACT or adoptive cell transfer, is a therapy of great interest to many patients. There are some small trials currently ongoing at the National Cancer Institute and a few other cancer centers. The patients in these trials—most of whom have metastatic disease usually have exhausted other treatment options, although some try it out first time around.

ACT involves removing some of a patient’s own immune-system cells, growing them in the laboratory, and infusing the cultured cells into the patient. The idea is to provide an invading force of immune cells that can attack tumors in a way that the immune system was incapable of doing on its own. The patient must undergo chemotherapy to first deplete the body of the current immune function and then gets high dose IL2 with the infusion of t-cells.

TIL Therapy requires intensive care hospitalization as it can be risky and highly toxic. According to Dr. Keith Flaherty, Director of the Center for Targeted Therapies at Mass General, “the balance of efficacy and safety has not been established to consider the TIL therapy as an option in relation to immunotherapies and Braf inhibitor based therapy. Clinical trials, randomized to other therapies are certainly lacking. It has been unclear whether the TIL therapy will be brought forward for consideration by regulatory agencies.”

The cost at NIH for the TIL therapy is said to be at $500,000 per patient. Funding is taxpayer underwritten. The high cost is due to lack of restrictions on the amount of scans and other procedures that normally health insurance companies would regulate as well as the intense labor it takes and time to go through the therapy. Several new biotech companies are forming around the concept of developing T-cell therapy as a treatment approach and that could lead to approval. There is still a long way to go for this therapy and the type of rigorous dated needed to judge its merits may come in the near future. Other institutions, (Moffitt and MD Anderson) have ACT programs but can’t seem to replicate the success rate of NCI. A major issue is that at the NIH, patients are very carefully selected for TIL to date (young, robust) and that makes it hard to understand if it could be generally relative to the majority of melanoma patients.

I have lost patients to this treatment and that has jaded my outlook. But they just couldn’t come back to a level of wellness to continue their struggle with melanoma after completing TIL. I do know a few patients who have had remarkable recoveries to no evidence of disease and I’m very happy they are doing well. But the numbers aren’t in and as Dr. Flaherty points out, we need to see randomized studies with larger numbers to prove TIL works. The cost may prohibit this from happening for some time.

In the meantime my personal opinion is that TIL is much like IL2, the response is amazing but only in a very small fraction of patients. I question where it may leave a patient once they have failed this therapy and whether they can realize improvement with something else. We have options for once in melanoma therapy and they seem to generate the most success when they have the least toxicity. Our immune system is a fragile entity that needs careful approaches.

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30 responses to “TIL Therapy for Melanoma: Magic Bullet? Or?”

  1. Avatar Dino says:

    I have a father who is been battling with melanoma stage 4 cancer. We are from Perth Australia. Thirteen years ago my father had a mole from his shoulder removed and we found out that was cancerous. He had a small surgery to get the skin around the mole cut out and according to the dr the surgery was a success. With dad living a normal life after that, ten years late he found a lump under his arm on the same side where he had the cancer removed. We didn’t really think anything of it as it was such a long time ago. After few weeks dad went to the dr just to make sure it wasn’t anything bad and that’s where it all started all over again.
    It was melanoma cancer, but we were still optimistic to have caught it early. Dad went in for a surgery and had it removed and did radiation for 4 weeks. Everything looked good except there was one little spot on his lung but it was so small that the Doctors didn’t know what it was. The dr suggested to come back after 3 month and to do a CT scan to see if there is any change to the small spot in his lung.
    3 month later and the CT scan with the worst news ever, it has spread to both of his lungs.
    5 different treatments and 3 years later we are still here but the dr in Australia told us that we are out of options, till we read your story and got hope again. Dads melanoma has spread to his liver, his mouth and now to his brain.
    How can we get in contact with someone to see if my dad can qualify for the trail?
    Do you know if we would be allegeable for the trail seeing that we are from Australia, and who would be the best contact for us to touch base with

    Kind Regards

    Dino

  2. Dino,
    I’m sorry this was not answered earlier. We had a glitch in our system. I hope you found a trial for your father. Please email me if you need further assistance: cpoole@melanomainternational.org

  3. Avatar Theresa says:

    I received TIL for Stage 4 melanoma in 2011. I still struggle with Melanoma, and I have a lot of health problems, like chronic pain that I didn’t have before. The jury is indeed out.

  4. Avatar Douglass Garibaldi says:

    Dear Catherine, Have had something in my right lung for a year. They keep on waiting 3 months and doing another CTscan. What about early detection? I was diagnosed with stage IIIA melanoma 5 1/2 years ago. I did an intense ipi trial which perforated by colon. Where are the centers of excellence in California especially in San Francisco ( if any) and Los Angeles?

    Thank you,

    Doug

    • Doug,
      I am sorry to hear of your issues. Perhaps the lung issue is not melanoma, sometimes there are things that show up on a scan that are benign. Otherwise, for San Francisco, we would suggest Univ. of California at San Francisco and for southern Ca. UCLA. Both have research in melanoma and stay current for therapy.

  5. Avatar Tzvia says:

    Hello there,

    I was wondering if you know of any hospitals or clinics in Canada?

  6. Avatar Jamie Tomasko says:

    I had the til trail at moffitt . 2 years and i am still stable i was stage 4 b lungs liver etc.. brain is clear i have scans every 3 months so far so good .jamie tomasko

    • Catherine Poole Catherine Poole says:

      That is a wonderful thing. Keep up the good work!

    • Avatar Mark says:

      Hi Jamie. This sounds like great news for you. My husband is about to go through the TILS trial. Can you give us any information that you can share about what you went through and how long the recovery period was.
      We are looking for support groups or online blogs where people share their stories.
      We would love to hear back from you and are so happy that it has worked for you.
      Looking so forward to hearing back from you.
      My husbands name is Mark.
      Thank you. Michelle

      • Catherine Poole Catherine Poole says:

        Michelle,
        Where is your husband doing the trial? Is it in a clinical trial?

        • Avatar Mark says:

          Hi Catherine. The trial is at Moffitt cancer center in Tampa FL. He is going on aug 21st to have a tumor removed from under his armpit. Hopefully they will use the moffitt lab for re-engineering the T-cells, which should take about three weeks we are told. We are a little worried about the strong chemo and then Interleukin after that. Mark had 8 months of Keytruda that worked great at first, then stopped. Then they tried Yervoy for 2 treatments and he had side effects that affected his liver enzymes and enlarged his gall bladder. The trial will be the third course of treatment. Would love to speak with anyone who has been through the treatment. Thanks so much for responding.
          Michelle

  7. Avatar Wendy Williams says:

    I was in a TIL trial at Moffitt 4 years ago. I have been in’ total remission for 2 years! My health has been very good for most of those 4 years.. I was 69 when I started the trial, so not just “young and robust” patients can have good results!

    • Catherine Poole Catherine Poole says:

      Thanks for reminder that this can work for older folks. But many of the trials were only accepting young people. It is a vigorous and depleting treatment. Happy you are doing well

  8. Avatar Dan Menter says:

    I had stage 4 and TIL with full body radiation split in Jan 2013. Had a 90% reduction then needed surgery to dissect one spot in leg. All clear but have vision and digestive issues.

  9. Avatar kimberly Keller says:

    Researching for a friend that is out of options. He is 34, stage 4 liver cancer. Not sure about lungs. Getting a scan this week on brain.
    Has there been any recent activity as this information is a couple of years old.

    Thank you!

  10. Avatar Linda says:

    Please tell me asap how, where to get my son in law treatment with TIL.
    He has been treated with immune therapy in California, for 5 years, and recently it’s gotten worse. He will go anywhere for the treatment!
    Please help!
    Thank you,
    Linda Feder
    847-767-7173

  11. Avatar Giovanni Floris says:

    Dear Catherine I was wondering if you know any hospitals or clinics in Europe. I live in Italy.
    Thanks a lot.
    Giovanni

  12. Avatar Angela says:

    Hello. My husband was diagnosed with Metastatic Melanoma (stage IV) in June. He is on his second round of immunotherapy (after having neurosurgery to remove the brain met).

    Do you know if there are any TIL treatment facilities in Colorado?

    Thanks for any information.

    Angela

  13. Avatar Ludmila says:

    Hello,

    My sister has malignant melanoma (stage III). This was identified after first surgery followed with immunotherapy (roferon ). The mutation p.VaI600Asp was identified. She is 45.
    Any chances for her on TIL or targeted therapy still may help? She is located in Europe.

    Thank you very much!

    Ludmila

  14. Avatar Yanic says:

    Hello,

    It seems that treatments for melanoma also work for mrcc. Are there any locations that are applying TIL to mrcc? Perhaps even as a clinical trial?

    • Catherine Poole Catherine Poole says:

      Actually there is a small percentage of therapies that work for both. You would have to contact the center offering TIL to see if they would accept you.

  15. Avatar Marc Ouellette says:

    A technical question: if I have low platelets, would I be able to get a platelet infusion before lymphodepletion in this TIL therapy? Would any center accept a 49 yo male other wise in good health to receive this treatment?

  16. Avatar Therese says:

    I am 4 years out from TIL study at NIH. Complete response, doing well working full time as RN. Had total body radiation, with chemo, TIL cells with high dose IL2. Did well with almost no lasting side effects.

  17. Is there any trials for TIL in the U.K. as I have ocular melanoma which has metastasis to liver and abdomen.i have exhausted all available treatments. Would really appreciate answer

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