APPs Weigh Earlier TIL Referral and Recovery Support in Melanoma

Raising tumor-infiltrating lymphocyte (TIL) cell therapy soon after first-line immunotherapy fails may give patients with advanced melanoma more time to benefit, but referral depends on travel, insurance, and preparing patients for an intensive inpatient course, according to advanced practice providers (APPs) at an Oncology Nursing News Case-Based Roundtable event.

The October 20, 2026, discussion was led by Lisa Kottschade, APRN, CNP, FAPO, a nurse practitioner at Mayo Clinic in Rochester, Minnesota.

What do the data show for lifileucel in advanced melanoma?

Lifileucel (Amtagvi) is manufactured from a patient’s resected tumor and infused after lymphodepleting chemotherapy, followed by up to 6 doses of high-dose interleukin-2 (IL-2).

In the 5-year analysis of the phase 2 C-144-01 study (NCT02360579), the objective response rate (ORR) was 31.4% among 153 patients with unresectable or metastatic melanoma previously treated with anti–PD-1 therapy. Median overall survival was 13.9 months, and the 5-year overall survival rate was 19.7%.¹

A retrospective real-world study of commercially released lifileucel reported an ORR of 44%. Response rates were 52% in patients with 2 or fewer prior lines of therapy and 33% in those with more than 2.²

Why are APPs raising TIL therapy earlier?

Because manufacturing takes weeks, participants said the conversation increasingly starts at first progression. “Both of the physicians that I work with, attendings in melanoma, they’ve started to challenge incorporating the idea of TIL sooner,” said Monica Mallek, NP, of UCLA Health in Los Angeles, California. “Harvesting earlier can actually be beneficial because then we can find out the viability of it and then also prepare them, and that can take weeks.”

How can nurses prepare patients for lymphodepletion and IL-2?

Participants said many patients with melanoma have never received chemotherapy. “Whatever imaginings they have about what chemotherapy is, I think LD chemo is that impression times 10 or times 100 perhaps,” said Suzanne McGettigan, CRNP, of Penn Medicine in Philadelphia, Pennsylvania.

Mallek said she reminds patients that lymphodepletion is temporary: “Information is power.”

IL-2 dosing is individualized, and doses are skipped or omitted based on tolerance.³ “I don’t know about you guys, but we very rarely get to all six doses. Four is kind of our average,” Kottschade said. In a meta-analysis of 676 patients presented this year, those who received 4 or fewer IL-2 doses had a complete response rate of 21% and a 1-year overall survival rate of 73%, compared with 9% and 54%, respectively, among those who received 6 or more doses.⁴

Ashley Garabeli, MMS, PA-C, of Moffitt Cancer Center in Tampa, Florida, said patients with multiple disease sites need to know that surgery targets viable tumor for manufacturing: “You’re going to wake up and still have palpable disease.”

Which adverse effects can appear after discharge?

Most toxicities occur early, from lymphodepletion and IL-2. “But we have been seeing some later effects and like a recurrence of their cytopenias and other complications, maybe a month after hospital discharge that are then persisting,” McGettigan said.

Erin Sharpe-Mills, NP, of Jefferson Health in Philadelphia, said 2 of her patients developed “eye disturbances like uveitis” 2 to 3 months later. Kottschade added that she has seen CD4 counts normalize “for several months and then all of a sudden, boom, it’s like way back down again.”

In a live poll, 57.1% of responding participants said managing adverse events during and after treatment is where they need the most support.

What logistical barriers affect TIL referral?

Lifileucel is given only at authorized treatment centers, of which there are at least 90 in the US and Canada.³ “The closest TIL facility is in Arizona. It’s in Phoenix, and a lot of our patients aren’t able to travel and go get that treatment,” said Jennifer Navarrete, NP, of the University of New Mexico Comprehensive Cancer Center in Albuquerque.

Insurance adds delays. “We have to have an insurance approval at, like, every step,” Kottschade said.

Nurses interviewed by Oncology Nursing News after the 2024 FDA approval of lifileucel similarly emphasized institution-specific IL-2 protocols.⁵ The roundtable reflected individual institutional experience, and the real-world and IL-2 analyses were retrospective.

What are the key takeaways for oncology nurses?

• Raise TIL therapy at first progression on immunotherapy so harvest timing and tumor viability can be assessed early.
• Prepare chemotherapy-naive patients for the intensity of lymphodepletion and the inpatient stay.
• Explain before admission that receiving fewer than 6 IL-2 doses is common and does not mean treatment has failed.
• Monitor for late cytopenias, CD4 count fluctuations, and uveitis in the months after discharge.
• Screen early for travel, caregiver, and insurance barriers, and clarify who manages post-discharge labs.

References

1. Medina T, Chesney JA, Kluger HM, et al. Long-term efficacy and safety of lifileucel tumor-infiltrating lymphocyte cell therapy in patients with advanced melanoma: a 5-year analysis of the C-144-01 study. J Clin Oncol. 2025;43(33):3565-3572. doi:10.1200/JCO-25-00765

2. Karapetyan L, Moser J, Ma BT, et al. Real-world, evidence-based, retrospective study of patients infused with commercially released lifileucel for advanced melanoma. Presented at: 2026 Tandem Meetings; February 4-7, 2026; Salt Lake City, UT. Abstract 48.

3. Betof Warner A, Hamid O, Komanduri K, et al. Expert consensus guidelines on management and best practices for tumor-infiltrating lymphocyte cell therapy. J Immunother Cancer. 2024;12(2):e008735. doi:10.1136/jitc-2023-008735

4. Ma BT, et al. Reduced IL-2 intensity and outcomes in TIL therapy: a meta-analysis. Transplant Cell Ther. 2026;32(2 suppl):S129. Abstract 155.

5. Dobkowski D. Experience, communication may help oncology nurses learn more about TIL therapy in advanced melanoma. Oncology Nursing News. February 22, 2024. Accessed October 27, 2026. https://www.oncnursingnews.com/view/experience-communication-may-help-oncology-nurses-learn-more-about-til-therapy-in-advanced-melanoma