By Ansley Franco
Patients with advanced melanoma now have a new option at the University of Alabama Birmingham, one that boosts their immune system to fight cancer. Tumor-infiltrating lymphocyte therapy (TIL) is a promising form of immunotherapy that harnesses and multiplies a patient’s cancer-fighting cells, then reintroduces them into the body to target tumors more aggressively.
A team of surgeons, medical oncologists, nurses, and social workers are leading the launch of the treatment at UAB, making it the only center in Alabama currently offering TIL therapy.
“I think of it as creating a supercharged cocktail of immune cells that are based on the patient’s actual tumor, which are infused into the patient to stimulate the immune system to treat the melanoma,” UAB surgical oncologist Kristy Broman, MD said.
The therapy begins in the operating room when a surgeon removes or harvests a viable section of the tumor, one that has sufficient volume that can increase the likelihood that the lymphocytes will grow.
“Melanoma can happen anywhere in the body, and when it’s metastatic, it can be anywhere in the body. So we can harvest from anywhere,” Broman said. “I’m always thinking: What is the lowest risk thing that I can do to harvest the tissue to enable the patient to recover and be ready for the next step, which is chemotherapy followed by the TIL infusion.”
After it’s been harvested, the sample is then shipped to a lab in Philadelphia, where the tumor sample is broken down and the immune cells are expanded over several weeks. Once ready, the cells are returned to UAB for re-infusion.
Before receiving the TIL infusion, patients undergo chemotherapy to suppress their existing immune system and make room for the incoming expanded lymphocytes. The actual infusion is administered intravenously during a weeks-long hospital stay.
“It’s not personalized medicine, it’s tumor-specific medicine, which is kind of cool,” Broman said. “The nice thing is that we’re seeing really good response rates, even in people who have not responded to other standard treatments, including other forms of immunotherapy. So it gives us a lot of hope to have another trick up our sleeve for those people for whom those standard immune therapies aren’t effective or their tumor becomes refractory.”
TIL therapy was FDA-approved in February 2024 for use in patients with metastatic melanoma who have stopped responding to standard immunotherapy drugs, like Keytruda or OPDIVO.
“This is the next step in harnessing the immune system’s power to attack the cancer,” UAB medical oncologist John Dubay, MD said. “With our current treatments, most patients will eventually progress on the treatment. This gives us a new option once they have progressed on our standard immunotherapy to have another treatment option.”
Ideal candidates are patients with metastatic melanoma who are still relatively healthy, and whose disease is progressing slowly. This is because the process of harvesting and reintroducing cells takes five to six weeks.
“We appreciate that the logistics of coming to Birmingham for care are challenging for a large proportion of our population who live far away, may not have a ton of resources for transportation, getting off work and those sorts of things,” Broman said. “Our navigators and social workers are critical members of our team who work tirelessly to address many of the barriers to receiving such an intensive treatment.”
Although UAB’s TIL therapy program launched only recently, it is ramping up quickly. The team first gained experience through a clinical trial, which provided valuable experience for implementing the treatment. While other institutions in the Southeast offer TIL therapy, Dubay said that UAB hopes to become a regional hub.
“I expect to see improvements in the procedure in terms of making it more effective by adding additional drugs or whatever needs to be done. Then, I think it’s going to be used in other cancers,” Dubay said. “It’s been studied in several others, including lung cancer, which would be a huge population.”