A groundbreaking tumor-infiltrating lymphocyte (TIL) therapy at Cleveland Clinic Cancer Institute has demonstrated remarkable efficacy in a 42-year-old woman with stage 4 conjunctival melanoma, marking a significant advancement in personalized cancer treatment.
The patient, who had previously failed multiple rounds of immunotherapy, experienced continued tumor shrinkage following the TIL treatment, which was administered in August 2024. This success represents Cleveland Clinic's first implementation of this innovative cellular therapy.
Disease Progression and Previous Treatments
Initially diagnosed with conjunctival melanoma in 2014, the patient underwent surgical excision of a mass in the eye's connective tissue. Following disease recurrence in 2020, she received standard immunotherapy with ipilimumab and nivolumab for two years. Despite treatment, the disease progressed to abdominal lymph nodes, and she experienced severe adverse events, including debilitating colitis requiring multiple medications and neurological complications resembling Bell's palsy.
Innovative TIL Therapy Approach
TIL therapy represents a personalized treatment approach that harnesses the patient's own immune system. The process involves extracting tumor-infiltrating lymphocytes - immune cells naturally present within the tumor that can recognize and destroy cancer cells - and expanding them in laboratory conditions before reinfusion.
The treatment protocol included:
- Surgical excision of tumor tissue
- Laboratory expansion of TIL cells
- Three-day lymphodepleting chemotherapy regimen
- One-time infusion of cultured TIL cells
- IL2 administration to activate and stimulate TIL multiplication
Patient Selection and Treatment Coordination
Dr. Lucy Kennedy, medical oncologist at Cleveland Clinic, emphasized the importance of patient selection: "The patient did amazingly well. She's been fighting this disease for years and suffered with severe toxicity before. It's been great to be able to offer TIL therapy and see her do so well."
The case underwent rigorous evaluation by both the Melanoma Tumor Board and Bone Marrow Transplant Committee. The patient's favorable characteristics - young age, absence of comorbidities, excellent performance status, and relatively small tumor burden - made her an ideal candidate for this challenging therapy.
Treatment Outcomes and Monitoring
Post-treatment results have been encouraging:
- Patient discharged after two weeks with no serious side effects
- Rapid return to normal activities
- Two consecutive scans confirming tumor shrinkage
- Ongoing monitoring shows continued response
The clinical team continues to track the patient's progress through regular imaging, anticipating further improvement as the TIL cells persist in targeting and eliminating cancer cells throughout the body.
