Tumor-infiltrating lymphocyte (TIL) therapy is a promising cancer treatment that harnesses the body’s immune system to fight cancer cells. Developed by Iovance Biotherapeutics, this one-time treatment offers hope for patients with relapsed, unresectable or metastatic melanoma who have exhausted traditional therapies.
How TIL therapy works
Dr. Melhem Solh, medical director of the cellular therapy program at Northside Hospital, explained that TIL therapy involves expanding the patient’s own immune cells to help fight melanoma.
“After harvesting, these cells are expanded in a lab and infused back into the patient to attack the cancer and get rid of it,” Dr. Solh said. “The one-time treatment requires close collaboration between Northside’s immunotherapy team, medical oncologists and highly specialized surgical oncologists.”
Determining patient eligibility
Dr. Solh said eligibility is based on many factors, including cancer stage, the patient's overall health (performance status), prior treatment and organ function.
“Patients must undergo a thorough series of tests, such as PET/CT or CT scans, surgical consultations and clearance, lab work and assessments of infectious disease markers and cardiac health,” he said.
Pre-infusion evaluations include additional tests like echocardiograms, pulmonary function tests and MRIs of the brain.
Tissue procurement for TIL therapy
Surgical oncologists play a crucial role in TIL therapy by procuring tumor tissue for T-cell manufacturing. According to Dr. Eddie Abdalla, a key surgical oncologist involved in Northside’s TIL therapy program, these specialists receive advanced training to optimize tumor extraction, focusing on site, size and handling techniques. The goal is to harvest a critical mass of tumor tissue, typically 2-5 centimeters, that meets FDA standards.
“TIL procurement is a unique challenge,” Dr. Abdalla said. “Unlike traditional surgeries where all tumors are removed, the objective here is to safely collect tissue for therapy while minimizing risk.
“Robotic surgery often allows for precise, minimally invasive extraction, enabling patients to recover quickly and move swiftly to the next phase of treatment.”
Qualifying for TIL therapy
Not all patients with metastatic melanoma automatically qualify for TIL therapy. Candidates must have previously undergone and failed BRAF inhibitors or PD-1 therapy, a standard checkpoint inhibitor treatment. In addition, physicians assess organ function and performance status to ensure the patient can tolerate the therapy. Social support is another critical factor, as patients need reliable transportation and assistance throughout their treatment journey.
Comprehensive care and collaboration
Managing TIL therapy patients requires a coordinated, multidisciplinary approach. “It takes a village,” Dr. Solh said. Northside ensures that all staff involved in patient care — from ER teams to ICU nurses — are trained to recognize and manage complications through risk evaluation and mitigation strategies (REMS). Prompt intervention is crucial when side effects arise.
Dr. Nicole Kounalakis, medical director of the Northside Hospital Cancer Institute melanoma and skin programs, highlighted that nearly 50% of melanoma patients eventually become resistant to standard treatments, making cellular therapies like TIL a crucial option.
Recovery and monitoring
Recovery from TIL therapy typically lasts about 30 days. During this time, patients are closely monitored for infections, fever and neurological changes. Rest and avoiding strenuous activities are essential for a successful recovery.
After the TIL infusion, patients are required to receive IL-2 (an immunotherapy treatment to work in combination with the TIL infusion). One major side effect of using TIL and IL-2 therapy could be a systemic inflammatory response as a result of the high dose of IL-2. These symptoms involve among others, fevers, chills, rapid heart rate and rapid breathing. Patients are monitored for a few days in the hospital during the IL-2 treatment.
A patient’s blood count may also go down for an extended amount of time because of the chemotherapy and the immune system’s activity, which may mean the patient needs to be supported with transfusions for a few weeks.
Why choose Northside for TIL therapy?
Northside Hospital stands out as the first approved TIL therapy center in Georgia. Its status as a national immunotherapy leader, combined with state-of-the-art facilities and expert teams, ensures high-quality care.
“We are excited to offer this novel therapy and improve outcomes for advanced-stage melanoma patients,” Dr. Kounalakis said.
“TIL is a treatment on the spectrum of groundbreaking therapies delivered at Northside Hospital Cancer Institute,” Dr. Abdalla added. “We continue to be among the national and international leaders in these therapies.
“I have managed patients for procurement and treatment at Northside from around the country, even from major cancer centers that have not achieved the fast-moving, safe, integrated cancer care programs available at Northside.”
Prospects and research
While TIL therapy currently focuses on melanoma, Dr. Solh envisions expanding its use to other solid tumors, with trials involving lung and endometrial cancers. Ongoing research aims to enhance the therapy’s safety and effectiveness.
“We are still at the beginning of what this therapy can achieve,” Dr. Solh said.
A proud milestone
Since launching its TIL therapy program in the spring of 2024, Northside has demonstrated its expertise in organizing and implementing complex cellular therapies. Drs. Solh, Abdalla and Kounalakis each feel immense pride in the program’s achievements and look forward to future advancements.
TIL therapy represents a groundbreaking step in cancer treatment, offering new hope to patients with limited options. Through cutting-edge science and compassionate care, Northside Hospital continues to lead the way in transforming cancer outcomes.
Learn more about TIL and immunotherapy at Northside.
Infographic source: National Cancer Institute
