Experience, Communication May Help Oncology Nurses Learn More About TIL Therapy in Advanced Melanoma

Experience, Communication May Help Oncology Nurses Learn More About TIL Therapy in Advanced Melanoma

With the recent FDA approval of the first tumor-infiltrating lymphocyte (TIL) therapy for the treatment of a solid tumor—unresectable or metastatic melanoma, to be exact—oncology nurses can play an important role in the preparation and administration of the adoptive cell therapy.

In particular, the FDA approved lifileucel (Amtagvi) for the treatment of adults with unresectable or metastatic melanoma who were previously treated with a PD-1 blocking antibody and a BRAF inhibitor with or without a MEK inhibitor if the patient’s disease is BRAF V600 positive.

Nurses play a crucial role in administering TIL therapy, particularly in coordinating patient care with the multidisciplinary team including physicians, APPs, pharmacists, and nurses. The nurses provide education to patients about the treatment process and possible adverse reactions. They maintain regular communication with the medical team and oncology pharmacists to promptly address any medication-related concerns during patient care.

Oncology Nursing News spoke with Pat Chambers, B.S.N., RN, a cellular immunotherapy nurse, and Jennifer Swank, PharmD, a clinical pharmacy specialist in medical oncology/internal medicine, both at Moffitt Cancer Center in Tampa, Florida, to learn more about TIL therapy and the role nurses can play throughout treatment.

What is TIL therapy and how is it administered? What role do nurses play in its administration?

Swank: TIL therapy is an adoptive cell therapy. Most people are aware of BiTE therapies or CAR T therapies, but TIL is another branch of adoptive cell therapy. You have to have a resectable tumor in order to create the TIL product. The tumor is resected. The TIL can be created within an internal lab or an external centralized lab. The T cells are isolated, they're expanded in IL-2, and then that creates the TIL product, which basically is revving up the immune system’s effects of those T cells. It's another form of manipulating the immune system to attack the cancers.

Not only has it been used in melanoma, which is the first FDA-approved indication; it's also been studied in a large majority of solid tumor cancers in other clinical trials, such as cervical cancer, lung cancer, just to name a few.

Chambers: Nurses care for the patient on both an outpatient and inpatient basis. We are in direct contact with the interdisciplinary team, including Jennifer from pharmacy, as we are caring for the patient. Most of the time, this is on an inpatient basis, as we educate the patient on potential side effects they may have from therapy.

From there, we are in daily contact with the pharmacist while the patient is receiving each dose of IL-2.

What advice would you give nurses about administering TIL therapy?

Swank: The couple pieces I see from a pharmacy perspective, is when administering IL-2 specifically, it's very important to have institution-based protocols on how to handle hypotension, decreased renal perfusion, the itching, the flushing, when the nurses can intervene, and then when a physician or a provider needs to be called. Those are not readily available, that you can print a national management protocol or national guidelines off the internet on how to manage these. It really takes a multidisciplinary approach between nursing, pharmacy, and the physicians and mid-level providers to create these order sets for your individual institution.

That's one of the largest challenges because you have to have that infrastructure in place if you're not used to giving these drugs. Most large academic medical centers do, smaller community organizations do not. I've actually worked with the drug company that developed the FDA-approved product to provide some educational sessions over the last couple of years as they've opened up the trial in smaller community settings. Hopefully, there'll be some additional literature being published soon as well, that will provide the nuts and bolts of these types of institution-based guidelines, because there's only a couple of good review articles out there that review the management. So there's not a ton of resources available in the literature on how to manage patients. I feel like that's the biggest challenge for these smaller centers.

Chambers: From a nursing perspective, this trial has been going on for years and the data has been collected for several years. We hope that we've seen all of the potential side effects from TIL therapy, and this should provide comfort to the patient as well.

What can oncology nurses expect when TIL therapy becomes more common in practice?

Chambers: From a nursing standpoint, we are caring for patients with various types of cancers each day. As you are learning more about administering TIL therapy for melanoma, just remember to be patient with yourself. I think experience is really what it's all about, just being able to say, I've done this trial.

The first time you administer TIL therapy, you will be focusing on the actual tasks associated with the therapy. After that, you will start to really absorb all the information to truly understand the benefits of this particular regimen and what signs and symptoms to look for. 

Swank: The other thing is that it does have a lot of different pieces. So these patients are going to be touched in the ambulatory infusion centers, in some type of an inpatient telemetry, ICU, cellular therapy unit. Probably a lot of these patients in smaller centers will probably be treated in more of an ICU-based setting. So they're touched by a lot of different groups throughout their journey until infusion. It's not only our really experienced inpatient specialty providers and specialty nurses, but they may potentially even be touched by some ICU nurses and oncology nurses. I don't know exactly what it will look like to nurses once it potentially is expanded to a larger market.

This transcript has been edited for clarity and conciseness.

Reference

FDA grants accelerated approval to lifileucel for unresectable or metastatic melanoma. FDA. February 16, 2024. Accessed February 16, 2024. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-lifileucel-unresectable-or-metastatic-melanoma