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Does TIL always come after Immuno and Targeted?
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Does TIL always come after Immuno and Targeted?

› Forums › General Melanoma Community › Does TIL always come after Immuno and Targeted?

  • Post
    • April 19, 2021 at 4:41 pm
    gopher38
    Participant
      Hello again,

      I’ll try not to spam the board with too many dumb questions, but had another come to me as I was perusing the clinical trials pages.  Is it your understanding that TIL would always come after checkpoint blockers and targeted therapy in the melanoma treatment hit parade?  My impression is that they usually start with nivo/pembro. If that fails, they go to combo, although an argument could be made for targeted therapy.  If combo fails and targeted is an option, then they go for that.  Intralesional might be mixed in there somewhere if the tumors are suitable.  Next in line would be TIL, but only after combo and/or targeted failed.  That’s my impression anyway, but I know I could be way off.

      I haven’t done targeted therapy yet, but I’m checking out clinical trail pages also.  Seems like I’ve seen some TIL trials where they require that you have failed both checkpoint blockers and targeted (when appropriate), but others where they don’t.  Just wondering if I should be looking at those at all at this point?  Would anyone in their right mind look at TIL before having gone through and failing nivo/ipi and/or targeted therapies?  Or is that completely reasonable, or course you’d look at TIL?

      Thanks in advance if you’ve got some info (or an opinion) here.

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    • Replies
        • April 19, 2021 at 5:38 pm
        Daisy2018
        Participant
          Hi there,

          I read some responses and it sounded like hard treatment, maybe even harder than targeted.
          This is what happens.

          After a one-week chemotherapy conditioning regimen, patients receive a single lifileucel infusion, followed by up to six doses of interleukin-2 (IL-2), a chemical messenger protein that promotes immune cell activity.

          I don’t think you have to fail immunotherapy and targeted therapy to qualify for it it. You can look at  government trials website and see if you qualify for it.
          I would do it before targeted therapy. I think in my opinion you get a better chance of long term effect vs short term of targeted therapy.
          It is my opinion and I don’t pretend to give professional advise.
          I think you need to be in a pretty good shape to go through it because it’s tough.
          They wipe out all your defenses and you need to get through it and recover. You maybe pretty sick.
          I would do if I could qualify. I will not now because of my sarcoidosis like lesions response to immunotherapy. Nobody would give me any immunotherapy until I clear up sarcoidosis.

          • April 19, 2021 at 8:04 pm
          Bubbles
          Participant
            I think you should consider TIL as well!!  Why not?  Data shows that while targeted therapy (for BRAF positive folks anyway) works quite well and rapidly – for most that response can be impermanent.  ALTHOUGH – there are exceptions who are maintained on targeted therapy for YEARS!  My thoughts are:

            Maybe cells for TIL could be harvested now and start cooking. Therefore be ready for use should you need them if targeted therapy doesn’t do what you need.

            Yes, there are some TIL processes in trials, which could be great, but TIL is a current and existing option – unless your docs have some reason that it isn’t.  TIL can be a bit brutal, so you have to be in pretty good shape to endure it.

            You could do targeted therapy and use TIL if it fails to give the lasting response you need.

            You could do TIL and plan to use targeted therapy if TIL doesn’t do what you need.

            All clear as mud, right?  Still, I would definitely look into these options and have a serious conversation about them with my doc.  Hang in there!  c

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