New immunotherapy against metastatic melanoma in basic package since January: ‘The tumor was completely gone, I couldn’t believe it’

Good news for people with metastatic skin cancer: From 15 January the so-called TIL therapy will be included in the basic package. The therapy is still under development, but appears to be a powerful weapon against some forms of cancer.

Last Christmas would be his last. Truus van Strien, then 64, had an aggressive form of skin cancer, with metastases all over her body. The doctors had informed her that he was off treatment.

Against all expectations

“It was in the middle of the coronavirus period and you could only invite a few people to visit us for Christmas. Then I said to my husband and children, ‘I want to see you all together again, with all the grandchildren, we’re just going with 14 men to celebrate.'”

But against all odds, 2021 didn’t become his last Christmas. “My oncologist in Breda referred me to an investigation at the Antoni van Leeuwenhoek in Amsterdam,” says Truus. “A number of people with my form of melanoma were able to participate, so I decided to give it a try.”

Immune cells blocked

It wasn’t easy: Truus was first intensively examined to determine whether her condition was good enough for this so-called TIL therapy (TIL stands for tumor-infiltrating lymphocytes).

It is a form of immunotherapy in which cells of the immune system are removed from the tumor itself. Immune cells that are, so to speak, stuck in the tumor and are no longer able to eliminate malignant cells.

Little steps

“We then grow these immune cells in the lab into a billion-dollar army that, once returned, is better able to fight cancer cells,” says internist-oncologist John Haanen of Antoni van Leeuwenhoek (AVL).

Haanen has been researching TIL therapy for years: “More than 10 years ago, we treated the first patient in the Netherlands. We are progressing in small steps, but we are learning more and more, and the group of patients benefiting from TIL therapy is growing .”.

Therapy in the basic package

The Zorginstituut announced a few days ago that TIL therapy will be reimbursed from the basic package for a larger group of melanoma patients from mid-January. It’s an important and hopeful step, according to Haanen.

“Up until now, we have only treated people with TIL therapy in a study setting. We will soon be able to offer this treatment to more patients, and in other hospitals as well.”

“It will be wrong again”

TIL therapy has worked out wonderfully well for Truus. “It was a very hard treatment, it hurt a lot. After 6 weeks a scan was done to see if anything had changed. The doctors then also wanted to take a biopsy from a metastasis in the neck. They searched with the ultrasound , but I couldn’t find the tumor. I thought then that a metastasis might have shrunk a little and had become hard to find.”

“But in the results interview after that first scan, the doctors said, ‘Sit down.’ Oh no, I thought, we’ve had bad news so many times, it must be very wrong again. Then they said, ‘We can’t find anything anymore, the cancer is completely gone.’ I just couldn’t believe it.”

“It doesn’t work so well for everyone”

“TIL therapy doesn’t work that well for everyone,” points out lead researcher John Haanen of the AVL. “For some people with skin cancer, this therapy does much less, if at all. We’re trying to figure out why that is, and what we can do about it.”

Researchers are also looking at what happens to other cancers when they’re treated with TIL therapy. “We are now conducting research on lung and cervical cancer, and hopefully breast cancer in the future as well,” says Haanen. “Hopefully this form of immunotherapy will work for that group of cancer patients as well.”

“Special Times for Oncologists”

“I think these are special times for oncologists,” says René Medema. He is chairman of the board and scientific director of the Netherlands Cancer Institute. “The field has moved tremendously. It’s not for nothing that all kinds of oncological developments have made headlines recently.”

“We’ve had years of basic research, immunotherapy, and more personalized cancer treatments. Everyone jumped in. All oncologists want to know: Why one treatment works for one patient and not for another. And how do we do it? We can now actually translate much of that patient research.”

65,000 euros per patient

There are other developments going on in oncology, and that has everything to do with the cost of the treatments. TIL therapy is currently still relatively expensive, costing around €65,000 per patient per year, but according to Haanen it could become cheaper if it becomes available to more patients.

“We didn’t need the help of the pharmaceutical industry in our research. And we want it to continue like this in the future.”

Special step

The AVL is therefore taking the special step of applying for approval for the same TIL therapy from EMA, the European Medicines Agency. “This is very unique,” agrees Haanen.

“We largely facilitate and manufacture the treatment ourselves, here in the hospital and at cost. This is a completely different amount than a pharmaceutical company would ask. So it will soon be a factor of 5.”

$3.8 million for TIL therapy registration

This week, KWF Cancer Control awarded €3.8 million to the Netherlands Cancer Institute to speed up the rather cumbersome registration of TIL therapy as a medicine. “Immunotherapy is one of the biggest recent breakthroughs in cancer research. We fund a lot of studies, but we also want the results to reach the patient as quickly as possible,” says KWF director Johan van de Gronden.

“It is unique that a research institute starts a European registration process for a medicine that has been developed and produced internally without the intervention of a pharmaceutical company. We want to support it.”