What to know about TIL therapy, a new treatment for skin cancer

A new cancer treatment being tested shows promise in fighting the most dangerous type of skin cancer and could help stop lung, head and neck, and cervical cancers as well.

The treatment uses a person’s own immune cells to get rid of cancer. Tumor-infiltrating lymphocytes (TIL), a type of immune cells that can fight cancer, naturally occur in the body and can infiltrate some types of solid tumors. Solid tumors are abnormal cells that form a mass of tissue inside an organ. These differ from liquid tumors, which develop in your blood, bone marrow or lymph nodes.

How TIL therapy works:

1. The solid tumor is removed from the patient during a surgery.
2. TIL from a piece of the tumor are removed from the tumor and grown outside of the body.
3. The TIL cells multiply until there are billions of them.
4. The cancer patient receives chemotherapy to deplete their pre-existing immune cells and make space for the TIL.
5. TIL cells are then given to the patient through an intravenous infusion.
6. Patients take an immunotherapy drug to help the TIL further expand and thrive inside their body, fighting off cancer cells.

Once inside the body, TIL enhances a person’s own immune system. TIL recognize unique genetic changes on the surface of each patient’s cancer cells and attack those cells. In that way, TIL therapy uses your own immune cells to help you battle cancer.

Where to find TIL therapy, and how it was developed

Steven Rosenberg, MD, PhD, a prominent physician-scientist at the National Institutes for Health, developed this approach to cancer treatment with his colleagues 35 years ago.

The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James) is among the first of 30 institutions in the country to be able to offer TIL treatment. The treatment is given to patients when certain types of advanced solid tumors haven’t been eliminated using standard immunotherapy or another targeted therapy approved by the U.S. Food and Drug Administration (FDA).

The clinical trials used this treatment for people with melanoma, the most dangerous type of skin cancer. In the next few years, TIL therapy will likely be used to treat other cancers, including cervical, lung, and head and neck cancers. TIL also has the potential to treat an aggressive type of breast cancer called triple-negative breast cancer.

What’s the success rate of TIL therapy?

Nearly half (49%) of patients with melanoma not eliminated with standard, FDA-approved treatments saw success with TIL therapy. Their tumors shrank. Of those patients, about 20% had their tumor eliminated, and they remained without cancer for many years.

This is very exciting. Researchers have never seen better results with any other type of immunotherapy used for cancer patients who have failed standard, FDA-approved treatments.

There’s a significant need for TIL therapy. About half of people with melanoma don’t respond to standard immunotherapy treatments to fight their cancer.

What are the side effects of TIL therapy?

If you receive TIL therapy, you might experience side effects from TIL, from the chemotherapy you receive before getting the TIL infusion or from the medication you receive after the TIL infusion.

Chemotherapy typically can cause typical side effects including: fatigue, hair loss, nausea, loss of appetite, potential organ damage to your liver, decreased white blood cells, red blood cells, and platelets, increased risk of infection, anemia and bleeding.

The TIL infusion is generally well-tolerated though you may develop mild to moderate flu-like symptoms such as fever, nausea and headaches.

You also could have side effects to the immunotherapy medication you’re given after the TIL infusion. Those possible side effects might include an irregular heartbeat, fluid in your lungs, difficulty breathing, a drop in blood pressure and confusion.

What’s the difference between TIL therapy and CAR T-cell therapy?

CAR (chimeric antigen receptor) T-cell therapy is another type of immunotherapy. CAR T-cell therapy uses immune cells called T-cells that are genetically modified in a lab. Those cells can only recognize a single protein or other molecule more highly expressed on the surface of cancer cells than normal cells. The genetically altered cells allow them to better identify and destroy cancer cells.

But CAR T-cell therapy involves a risk of significant side effects, including organ damage as well as inflammation in the brain and resulting cognitive changes. CAR-T cells also could become cancerous, while TIL cells cannot.

TIL cells are naturally occurring — not genetically engineered. TIL cells are able to recognize multiple targets on the surface of cancer cells that are not expressed on normal cells.

Is TIL therapy approved by the FDA?

The FDA has just approved the first TIL therapy, a product called Amtagvi. It’s available to patients at 30 treatment centers across the country, including the OSUCCC – James.

Amtagvi is made by Iovance Biotherapeutics, which is based in California.

The future for TIL therapy is exciting. TIL therapy can offer hope to people with melanoma who have failed other treatments. It’s a powerful therapy that can give you a better chance of keeping cancer under control long-term.