Tumor-infiltrating lymphocyte therapy is a type of immunotherapy that uses your immune system to fight cancer. Key points to know about TIL therapy:

• It can help people with melanoma that has spread to other parts of the body who are running out of treatment options.
• It can help people with melanoma that can’t be removed with surgery who are running out of treatment options.
• It’s a “living” medicine made from your own blood cells.
• It’s a complex and demanding treatment that requires care from a team of expert providers.
• Treatment and recovery takes about 10 weeks.
• OHSU is a national leader in immunotherapy and played a key role in developing CAR T-cell therapy, which is similar to TIL therapy. We are the only hospital in the Pacific Northwest to offer TIL therapy treatment.

What are tumor-infiltrating lymphocytes?

Lymphocytes are white blood cells. They are the guardians of your immune system and part of your natural defenses against cancer. They circulate through your body hunting for cancer cells, germs and other things that don’t belong.

When lymphocytes find a tumor, they latch onto it and go through a process called activation. Once activated, they enter the tumor and attack cancer cells. They make copies of themselves to strengthen the attack. 

These activated lymphocytes are called tumor-infiltrating lymphocytes, or TILs. The longer they stay inside the tumor, the better they get at recognizing and destroying cancer cells.

Sometimes tumors fight back. They send out chemical signals that switch the TILs off so they stop attacking.

What is TIL therapy?

TIL therapy recharges your immune system to fight cancer.

Doctors remove some of the TILs that were switched off by your cancer. They keep them alive, switch them back on and give them extra energy. They make billions of these living, high-energy TILs.

They put the new TILs in your body, where they surge through your system to attack the tumor and hunt down cancer cells.

How does TIL therapy work?

TIL therapy is a complex, demanding treatment. We’ll strive to arrange your procedures based on your needs and wishes. Our goal is to make things as easy as possible for you and your family. 

Here's how it works:

• Biopsy: Surgeons remove a piece of tissue from your tumor about the size of a grape. This procedure may be simple or complex, depending on where your tumor is. If the surgery is complex, you may spend a few days in the hospital.
• Manufacture: Doctors chill the sample to keep your TILs alive. A lab uses advanced technology to wake up the TILs and make billions of copies. This takes about five weeks, but you don’t have to stay in the hospital while it’s going on.
• Preparation: You’re admitted to the hospital. You get chemotherapy medicine every day for seven days through an IV in your arm. This suppresses your immune system and strips away the tumor’s defenses. Each dose takes about two hours.
• TIL infusion: Doctors deliver the TILs through an IV in your arm for about two hours.
• Activation: You get a medicine called interleukin-2 to activate your new TILs. The TILs circulate to attack tumors and hunt down cancer cells everywhere in your body. You get six doses through an IV in your arm. Each dose takes about two hours. The doses are given 12 hours apart. 
• Monitoring: You stay in the hospital for a few days so we can see how you’re doing.
• Recovery: It takes your immune system several weeks to regain strength. Plan to stay within one hour of the hospital until your immune system recovers.

Treatment and recovery takes about 10 weeks start to finish. If the treatment works, the TILs should stay active for years.

How do we support you through TIL therapy?

We know that cancer is hard on patients and their families. We have a wide range of services to support you, including:

• Rood Family Pavilion: Out-of-town patients can stay at our guest house. You may qualify for free or reduced rates.
• Social workers: Our team can provide emotional support, and help with needs like lodging and transportation.
• Rehabilitation: Physical therapists, speech therapists and occupational therapists can help you recover.

Learn more about the support services we offer you and your family.

What types of cancer is TIL therapy used for?

TIL therapy may help some people with advanced cancer who have already tried other treatments.

In February 2024, the U.S. Food and Drug Administration approved TIL therapy for some people with advanced melanoma. This includes:

• Metastatic melanoma (melanoma that has spread)
• Unresectable melanoma (melanoma that cannot be removed by surgery)

TIL therapy is for people who have already received treatments like PD-1 inhibitors or BRAF inhibitors, but whose melanoma has gotten worse.

OHSU researchers are running clinical trials to see if TIL therapy can help people with other types of cancer, including:

• Colorectal cancer
• Non-small-cell lung cancer

If you have cancer, consider joining one of our cancer clinical trials.

Benefits of TIL therapy

TIL therapy has several potential benefits, depending on how your cancer responds to treatment.

You may:

• Have fewer symptoms and feel healthier.
• Be able to enjoy more activities.
• Live longer.

A 2023 study followed 153 patients with late-stage melanoma that had spread or couldn’t be treated with surgery. These patients had tried other treatments, but their cancer kept getting worse.

After TIL therapy, the study found that:

• 41% of patients got a little better or stayed the same.
• 31% of patients got a lot better. Their tumors got smaller or went away.
• 19% of patients saw no benefit. Their cancer got worse.

Limits of TIL therapy

It’s important to know the limits and risks of TIL therapy:

• It doesn’t always work.
• Sometimes the tumors don’t contain enough TILs for the therapy to work.
• It takes four or five weeks to make copies of the TILs. 
• You will spend two weeks in the hospital.
• Treatment will weaken your immune system for a few weeks, and you’ll need to stay near the hospital while you recover.

You may have side effects during treatment, though they usually go away after two weeks. The most common ones include:

• Fever
• Chills
• Risk of infection
• Tiredness
• Irregular heartbeat
• Rash
• Low blood pressure
• Diarrhea
   

How do you pay for TIL therapy?

Check with your insurance provider. Iovance Biotherapeutics, the company that makes Amtagvi (the therapy’s brand name), has tools and resources to help you work with your insurance provider.

OHSU can also help you with questions about billing and insurance. If you don’t have insurance, you may qualify for free or discounted care.

What makes us different

• Our doctors and scientists have earned an international reputation for leadership in immunotherapy.
• We have decades of experience taking care of people with melanoma.
• We have a team of specialists to care for you before, during and after treatment.
• We offer a range of support services for patients and families.