What happens when melanoma treatment stops working?

When a patient’s cancer treatment is no longer working well, it doesn’t mean all hope is lost, especially for people living with advanced melanoma.

“Learning your current treatment method isn’t working to properly fight cancer can feel extremely disheartening for patients and families,” says Dr. Yogesh Jethava, an oncologist at Advocate Health Care. “Between processing the news of a diagnosis to undergoing treatment, facing more hardship only adds to the emotional and physical toll cancer takes on a person. The good news is just because one form of treatment is no longer working, it doesn’t necessarily mean there are no other options. Every patient’s cancer responds differently to treatment. There is no ‘one-size-fits-all,’ so oftentimes we need to explore multiple avenues to determine what will work best.”

New immunotherapy treatment for melanoma 

For many people with advanced melanoma, immune checkpoint inhibitors (anti-PD-1 drugs) are the first line of treatment. Many people whose tumors carry a BRAF mutation, which causes uncontrolled cell division, may also receive targeted therapy. When the cancer keeps growing despite these treatments, options have historically been limited. Thanks to a newer form of immunotherapy known as TIL therapy, that has changed.

How TIL therapy treatment works

When tumors are present in the body, white blood cells called lymphocytes move into the tumor and attack cancer cells, but often there aren’t enough of them to win the fight.

During TIL therapy, surgeons remove a piece of the patient’s tumor. The lymphocytes are separated from it and multiplied by the billions in a specialized lab. Before the cells are returned, the patient receives a short course of chemotherapy that makes room in the immune system for the new cells. The patient then receives a single infusion of their own expanded T cells, followed by doses of interleukin-2 (IL-2), a medicine that helps the cells stay active as they seek out and destroy cancer.

“TIL therapy is a great example of how we can use what the body is already creating to effectively fight cancer,” says Dr. Jethava.

What to expect with TIL therapy

This type of treatment may be appropriate for adults with melanoma that cannot be removed with surgery or has spread, those who have already been treated with an anti-PD-1 therapy and if their tumor has a specific BRAF mutation.

TIL therapy is given only at authorized treatment centers and typically involves a hospital stay for the chemotherapy, infusion and IL-2 doses. Because the treatment is intensive, it carries serious risks, including low blood counts, infections, and heart, lung and kidney problems, so patients are monitored closely throughout. If you have melanoma, your care team will review whether you’re healthy enough for the process.

“If you have been undergoing cancer treatment and have been told it is no longer working as it should, talk with your care team about next steps,” Dr. Jethava says. “Thanks to newer treatments like TIL therapy, our options are increasing.”

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