Commonwealth _ Toni English’s medical team could barely contain their excitement. It had been six weeks since English, who was in her 60s, had completed an experimental cancer treatment. She arrived at the Orlando Health Cancer Institute in Florida with her husband, anxious but hopeful, for the results of her latest scan.
Her team assembled in a patient exam room on the second floor, where the energy in the room was palpable. English sensed something extraordinary. As her oncologist prepared to share the results, someone even held up a phone, ready to capture the moment. The oncologist pointed to the computer screen and pulled up an image from before treatment. “Here’s the picture of your lungs before treatment,” he said. In her left lung, a tumor about the size of a nectarine was clearly visible as a white, bulbous splotch. Then he clicked to her most recent scan. That ominous white spot had completely vanished. “It was history,” English says, remembering the relief and disbelief that followed. The room fell quiet as her team waited for her response. She paused, and then, with an almost casual air, said, “Well, good! Isn’t that what we were expecting?”
English had every reason to be cautiously optimistic. She had been battling a rare and aggressive cancer known as mucosal melanoma. The disease is notoriously difficult to treat, and only about 25% of patients survive five years after diagnosis. English’s cancer had metastasized, spreading from its origin in her nose to her lungs, kidney, and brain.
Standard therapies, such as surgery, radiation, and immunotherapy, can shrink tumors and control the spread of the disease, but they do not work for everyone. For three years, English had endured grueling rounds of treatments. Reflecting on that period, she recalls, “It was pretty rough,” but adds, “I was just doing what I had to do.” Despite her resilience, her cancer persisted. With options dwindling, her doctor mentioned a clinical trial for a new treatment that offered a glimmer of hope.
The trial was testing a groundbreaking therapy developed by Iovance Biotherapeutics. Unlike anything English had tried before, this was a “living drug” made from immune cells called T cells. The therapy, known as tumor-infiltrating lymphocyte (TIL) therapy, extracts T cells from a patient’s tumor, cultivates billions of them in a lab, and then reinfuses them back into the patient’s body. These T cells, already naturally inclined to attack cancer, are supercharged to hunt down and destroy the malignant cells. In some cases, they appear to eradicate the cancer entirely.
Six years have passed since English’s life-changing scan, and TIL therapy has since become available to more patients. In February, the U.S. Food and Drug Administration approved Iovance’s TIL therapy, called lifileucel, under the brand name Amtagvi, for treating advanced melanoma. While T cell therapies that engineer a patient’s cells have been used successfully for blood cancers, this is the first FDA-approved T cell therapy for solid tumors. Solid tumors account for 90% of new cancer cases globally and could result in more than 550,000 deaths in the U.S. this year alone.
However, TIL therapy, like many cancer treatments, isn’t a universal cure. Amtagvi didn’t work for everyone in the trial. Of the 73 advanced melanoma patients who participated in the study leading to FDA approval, only three, including English, saw their cancer disappear. Nonetheless, nearly a third of the patients experienced some benefit from the treatment. While these numbers may seem modest, for those individuals who respond, TIL therapy can be a lifesaver.
