Journal: British journal of cancer
This Perspective article discusses how tumour-infiltrating lymphocyte (TIL) therapy—now commercially available as lifileucel (Amtagvi)—can be integrated into routine care for advanced melanoma.
Key points:
- Clinical context:
- • TIL therapy can produce durable responses in a subset of patients with advanced melanoma, particularly after failure of immune checkpoint inhibitors and/or targeted therapy.
- • Recent regulatory approvals in the US (FDA) and Canada have established lifileucel as the first commercially manufactured autologous TIL product for solid tumours. Regulatory and funding decisions in the UK and Europe are still ongoing.
- Implementation challenges:
- • Successful delivery of TIL therapy requires tight coordination of:
- • Patient selection and timing (often late-line, post-ICI/targeted therapy).
- • Surgical tumour procurement for TIL harvest.
- • Centralised manufacturing and logistics (vein-to-vein time, product viability).
- • Lymphodepleting chemotherapy and high-dose IL-2 administration.
- • These steps demand specialised infrastructure, experienced centres, and robust multidisciplinary pathways.
- Health system and economic considerations:
- • The high cost of a commercial ATMP such as lifileucel necessitates formal health economic evaluation and prioritisation frameworks.
- • Nationally aligned criteria for referral, eligibility, and sequencing relative to other systemic options are needed to ensure appropriate use and equity of access.
- Service design and national coordination:
- • The authors advocate for:
- • Nationally coordinated clinical prioritisation, guided by specialist tumour boards.
- • Oversight mechanisms to monitor outcomes, safety, and access disparities.
- • Strategic planning for future decentralised or hybrid manufacturing capacity to improve resilience and scalability.
- • Networks like the UK Advanced Therapy Treatment Centre (ATTC) Network are highlighted as models to support phased rollout, knowledge sharing, and equity-focused service design.
Overall, the article frames TIL therapy not just as a promising treatment, but as a complex ATMP that requires system-level planning, national coordination, and careful economic evaluation to be safely and equitably adopted.