Canadian Patients With Metastatic Melanoma Face Life-Threatening Delays as TIL Therapy Awaits Provincial Funding
Key Insights
Health Canada approved lifileucel (Amtagvi), a tumor-infiltrating lymphocyte therapy for metastatic melanoma (search), in August 2025, but no province has yet agreed to publicly fund it.
Ontario patients seeking out-of-country coverage for TIL therapy at U.S. centers have been uniformly rejected, with the province citing the ongoing pan-Canadian Pharmaceutical Alliance (search) review process.
The average time from Health Canada approval to provincial funding in Canada is approximately 730 days, longer than in any other G7 country.
Alex Shved, a 37-year-old father of two from Etobicoke, Ontario, is battling Stage 4 metastatic melanoma (search) on two fronts: the cancer that has spread to his bones and lungs, and a health-care bureaucracy that has denied him access to a Health Canada-approved therapy that could extend his life.
Shved's oncologist recommended tumor-infiltrating lymphocyte (TIL) therapy, a bespoke immunotherapy in which doctors remove a patient's tumors, extract immune cells that have infiltrated those tumors, multiply them into the billions, and then infuse them back into the patient following high-dose chemotherapy. A commercial version of this treatment, lifileucel (brand name Amtagvi), manufactured by California-based Iovance Biotherapeutics, received Health Canada approval in August 2025.
Despite that regulatory green light, lifileucel remains unavailable in Canada outside of clinical trials. The therapy is still undergoing review for public funding — a multistage process that, on average, takes 730 days from Health Canada approval to a provincial funding decision, according to Dr. Joel Lexchin, professor emeritus at York University's school of health policy and management. That timeline is longer than in any other G7 country.
Out-of-country funding requests denied
Shved applied to Ontario's Out-Of-Country Prior Approval Program, seeking coverage to receive TIL therapy at the Moffitt Cancer Center in Florida, at an estimated cost of approximately $1 million. The Ministry of Health rejected his application this spring.
"The (Out-Of-Country) Prior Approval Program is not a mechanism to provide interim drug funding for indications that are currently being reviewed or expected to be reviewed for public funding in Ontario," the rejection letter stated.
Shved described the response as "a bit of a slap in the face," noting that the regulations governing Ontario's out-of-country coverage do not explicitly mention interim funding periods as a basis for denial. "To have the government reject it without even, frankly, looking at your case, without considering your situation, just applying some categorical copy-and-paste legal statement that doesn't exist in the policy," he said.
He is not alone. Elizabeth Stewart, 48, a triathlete and mother from Guelph, and Kevin Nash, 58, a father of three from Haliburton, also had their out-of-country applications rejected on identical grounds. Their cases follow that of Evan Armit, a 23-year-old elite hockey player and business student who died of melanoma last summer after his own appeal was denied by the Health Services Appeal and Review Board (HSARB).
The funding review bottleneck
The Ministry of Health, through spokesperson W.D. Lighthall, stated that provinces participating in the pan-Canadian Pharmaceutical Alliance (search) (pCPA) do not provide out-of-country funding for drugs that have not completed the established review and funding process. "Once that process is complete, each participating jurisdiction will independently decide whether to publicly fund the therapy for eligible patients," Lighthall wrote. "Consistent with this approach, there have been no instances of Ontario approving out-of-country funding for a drug while it was actively undergoing the national (drug) negotiation process."
Before pCPA pricing negotiations can begin, lifileucel must first receive a recommendation from Canada's Drug Agency (search) (CDA). Iovance Biotherapeutics did not file its submission to the CDA until June 18, 2026 — approximately 10 months after Health Canada approval. A draft recommendation is expected in November 2026, according to CDA spokeswoman Erin Brophy.
Iovance spokeswoman Jen Saunders said the company is "coordinating urgently to align these various moving parts to offer Amtagvi in Canada as quickly as possible," citing the need to authorize and qualify treatment centers for the complex, individualized cell therapy.
Clinical evidence and cost considerations
In the small trial that led to FDA and Health Canada approval of lifileucel, approximately one-third of participants experienced some reduction in tumor size. Dr. Marcus Butler, a medical oncologist and site lead for melanoma/skin oncology at Princess Margaret Cancer Centre in Toronto, noted that TIL therapy "is not a cure or an easy treatment to take," but emphasized that it represents an option when other treatments have stopped working for patients with aggressive melanoma.
Lifileucel carries a U.S. list price of US$515,000 for the one-time infusion, excluding hospitalization costs that typically span several weeks. Dr. Lexchin suggested that Ontario's reluctance to fund out-of-country treatment may stem from cost differentials: "The public payers are looking at it from the point of view of well, on average American drug prices for patented drugs are between two-and-a-half and three times the Canadian price."
The customized nature of TIL therapy — manufactured one batch at a time from a specific patient's tumor — also makes it a poor fit for existing access mechanisms. Ontario's pilot program that has begun paying for certain new cancer drugs at the outset of pCPA negotiations, as well as pharmaceutical company compassionate access programs, are designed primarily for off-the-shelf medications.
Legal challenges and the path forward
Shved has appealed his rejection to HSARB, filed an application for judicial review, submitted freedom-of-information requests, and contacted dozens of politicians. Health Minister Sylvia Jones called Shved after his story appeared in the Globe and Mail, but told him she cannot intervene in individual cases.
The odds at HSARB are daunting: according to an analysis by Tribunal Watch Ontario, the success rate for applicants at the tribunal since 2023 is less than 1 percent.
Stewart has launched a GoFundMe campaign aiming to raise $1.7 million for TIL therapy in Florida, with more than $500,000 donated to date. Shved, meanwhile, hopes his judicial review will have broader implications.
"I feel a duty to do this on behalf of both myself and lots of other people," Shved said. "Maybe they don't have the time, the energy, or the health span to fight this."
His legal challenge, if successful, could "set a precedent for all future out-of-country applications, so that many other people who are in my situation and Evan's situation and situations where they have other cancers can use the out-of-country program to get them the therapy that they desperately need."