Melanoma is one of the most aggressive types of skin cancer and quickly spreads throughout the body unless it’s caught. Advanced melanoma, defined as too extensive to surgically remove (unresectable) or with metastatic spread to other organs of the body, can be very difficult to treat and has a low overall survival rate.  However, new research is yielding insights into how the body’s own immune system can be used to fight this cancer.  Adoptive cell transfer with “autologous tumor-infiltrating lymphocytes” (TIL therapy) is a new form of advanced melanoma treatment that is showing promising results. 

How it works:

  1. Tumor-infiltrating lymphocytes (TILs) are naturally occurring immune T-cells that infiltrate a tumor trying to fight it.
  2. Some of the patient’s tumor burden is surgically removed, and the TILs are extracted from that specimen.  These TILs, which recognize the tumor as being foreign, are then expanded and infused back into the patient.

Published results from a recent clinical trial involved treating 66 patients with advanced (unresectable or metastatic) melanoma. All patients had received at least one and in some cases three other systemic treatments.  36% of the patients responded to the treatment, including  2 complete responses and 22 partial responses.  Twenty-nine patients showed stable disease meaning the tumor was not advancing.  In total, there was a disease control rate of 80%.

At 33.1 months follow-up, amazingly the median duration of response still had not been reached (range, 2.2-38.5+ months). (The “duration of response” is the length of time that a tumor continues to respond to treatment without the cancer growing or spreading.  The longer the DoR, the better. When the researchers stopped to do follow up, some patients were still having a response from the drug, so a median DoR could not be calculated.)

The most common side effects included thrombocytopenia (low platelet levels), chills, anemia, and febrile neutropenia, a condition that  can increase the risk of infections. 

Furthermore, long-term follow up data suggests a greater survival benefit when patients are first treated by TIL therapy as opposed to TIL after treatment with other systemic treatments.  Both objective response rate and melanoma-specific survival was increased in TIL naïve patients. Researchers postulate whether harvesting the TILs prior to these other treatments could possibly increase survival by providing untouched T-cells in case of tumor progression.

A current study is looking at the effects of re-treatment with TIL therapy.

The results of TIL therapy are encouraging and could represent a significant advancement in the treatment of advanced melanoma and other solid tumors.

Anne Truitt, MD, is a board certified dermatologist and Mohs micrographic surgeon in San Diego, CA Visit www.skinsurgerymed.com Instagram: www.instagram.com/dr.truitt_sandiego