TIL Therapy in Melanoma: APPs Urge Earlier Referral, Late-Toxicity Plans

Identifying candidates for lifileucel (Amtagvi) earlier in the disease course, and planning for toxicities that can surface months after discharge, emerged as central themes during an Oncology Nursing News Case-Based Roundtable on tumor-infiltrating lymphocyte (TIL) cell therapy in advanced melanoma.

The virtual event was moderated by Kristin Ferguson, DNP, RN, OCN, senior director of bone marrow transplant and cell therapy at MedStar Georgetown University Hospital in Washington, DC. Panelists included nurse practitioners and physician assistants from Massachusetts General Hospital, Moffitt Cancer Center, Mayo Clinic, Johns Hopkins, Weill Cornell Medicine, Stanford Health Care, USC, Sylvester Comprehensive Cancer Center, and Providence Saint John's Health Center.

What does the evidence show for TIL therapy after immunotherapy?

Lifileucel, a one-time autologous TIL therapy, received FDA accelerated approval in February 2024 for unresectable or metastatic melanoma after progression on anti–PD-1 therapy. Its delivery depends on close nursing and pharmacy collaboration.¹

In the 5-year analysis of the phase 2 C-144-01 study (NCT02360579), which enrolled 153 patients previously treated with anti–PD-1 therapy, the objective response rate (ORR) was 31.4% and the 5-year overall survival (OS) rate was 19.7%.²

Real-world data presented at the 2026 Tandem Meetings suggested that timing matters. In a retrospective analysis of 41 patients treated with commercial lifileucel at 4 US centers, the ORR was 44%. Responses occurred in 52% of patients with 2 or fewer prior lines of therapy vs 33% of those with more than 2.³

Why does early identification of TIL candidates matter?

Megan Schollenberger, MSN, CRNP, a nurse practitioner at Johns Hopkins, said her team tries to avoid needing TIL therapy on short notice "because it takes 8, 12 weeks just to get the insurance clearance, get the patients to surgery, get the surgery done, have the TIL cells grow, get them started on lymphodepletion. So we try to plan ahead of time for that."

Panelists noted that patients referred after several lines of therapy are often more fragile, may need bridging therapy, and may still be recovering from immune-related adverse events. Strategies to move referrals earlier included community outreach talks and regional multidisciplinary tumor boards.

Melody Simanian, PA-C, a physician assistant at Providence Saint John's Health Center in Santa Monica, California, said her surgical practice introduces TIL therapy at a patient's first consultation, before nodal status is known. "So if it's ever needed, they've heard of the term before," she said.

How should nurses explain IL-2 dosing to patients?

After the TIL infusion, patients receive high-dose interleukin-2 (IL-2) every 8 to 12 hours for up to 6 doses. Ferguson emphasized that doses are skipped rather than delayed. "If a patient cannot tolerate the next dose, you skip that dose and you wait your 8 to 12 hours and see if they can get the next dose," she said.

A meta-analysis of 676 patients found that those who received 4 or fewer IL-2 doses had a complete response rate of 21% and a 1-year OS rate of 73%, compared with 9% and 54%, respectively, among those who received 6 or more doses; ORRs were 48% and 42%.⁴ Panelists said framing fewer doses as appropriate, not as treatment failure, should begin with pretreatment education.

What toxicities can appear after discharge?

Panelists described toxicities extending well beyond the inpatient stay, including uveitis 1 to 2 months after discharge, pulmonary complications, red cell aplasia, and recurrent cytopenias requiring readmission.

Krista Rubin, MS, FNP-BC, a nurse practitioner at the Massachusetts General Hospital Center for Melanoma, said some patients have had "a prolonged duration of low CD4 counts," requiring antiviral prophylaxis longer than anticipated. "We thought a lot of the labs that were being drawn post-TIL were overkill for melanoma patients," she said, adding that the monitoring had proved more relevant than expected.

A single-center retrospective study from Memorial Sloan Kettering Cancer Center (n = 51) found that 22% of patients were readmitted after discharge, most often for disease progression. Two patients (3.9%) developed a new grade 3 treatment-related adverse event, at 73 and 104 days after discharge.⁵ The authors called for TIL-specific postdischarge guidelines. Ferguson noted that many programs, including hers, have adapted CAR T-cell therapy monitoring protocols in the absence of such guidance.

In a live poll, more than half of participants identified managing adverse events during and after treatment as the part of the TIL journey where they need more support.

What are the key takeaways for oncology nurses?

• Raise TIL therapy early. Responses were higher with fewer prior lines, and preparation takes weeks.³
• Review medication lists before admission. Schollenberger flagged antihypertensives and adrenal insufficiency as issues to coordinate with cardiology and endocrinology ahead of lymphodepletion and IL-2.
• Set IL-2 expectations up front. Explain that skipped doses reflect tolerability, not failure.
• Address logistics. Patients need a caregiver throughout treatment and often lodging near an authorized treatment center.
• Plan for late toxicities. Define whom patients should call after discharge and monitor for delayed cytopenias and inflammatory events.

References

1. Dobkowski D. TIL therapy for advanced melanoma requires nursing, pharmacy collaboration. Oncology Nursing News. March 6, 2024. Accessed October 27, 2026. https://www.oncnursingnews.com/view/til-therapy-for-advanced-melanoma-requires-nursing-pharmacy-collaboration
2. 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
3. Karapetyan L, Moser J, Ma BT, et al. Real-world, evidence-based, retrospective study of patients infused with commercially released lifileucel for unresectable or metastatic melanoma. Presented at: 2026 Tandem Meetings; February 4-7, 2026; Salt Lake City, UT. Abstract 48.
4. Ma BT, et al. [Title to verify]. Transplant Cell Ther. 2026;32(2 suppl):S129. Abstract 155.
5. Andreoli M, Kalvin HL, Cathcart ER, et al. Outpatient treatment-related toxicity after hospital discharge among patients receiving lifileucel for advanced melanoma. JCO Oncol Pract. Published online August 25, 2026. doi:10.1200/OP-26-00407