TIL, then: Why Cooper doctor is excited to bring novel melanoma treatment to South Jersey region

If surgical oncologist Dr. Young K. Hong had a guess — maybe a hope — where medicine is headed: It’s toward every patient having treatment that’s totally individualized and unique to them.

And he’s long been determined to have Cooper University Health Care lead the way.

Hong, director of cellular therapy and clinical research and a Division of Surgical Oncology chief at Cooper, has a strong conviction about emerging cell therapy treatments, particularly for potentially deadly, late-stage melanomas.

That conviction, which he admits is a near-religious zeal, stems from seeing firsthand the potential of treating patients with tumor-infiltrating lymphocytes, or TIL. He describes it as one of the most personalized forms of cancer care there is.

“The way it works is, we take the person’s own cancer via surgery, and inside the tumor we isolate the tumor-reactive T-cells that are unique to them and them only,” he said. “There’s less than 1% shared protein antigens between two patients, so one person’s TIL won’t work on another’s melanoma. It’s only going to work for that patient you took the cells from.”

Hong wants to bring this novel therapy to the South Jersey region. He and Cooper are doing just that.

His time with it dates back to a 2010 National Institutes of Health fellowship program, where he worked under immunotherapy pioneer Dr. Steven Rosenberg, inventor of the TIL treatment.

“That left an impression on me, because there were patients who were cured of their metastatic melanoma from that treatment from then that I still keep in touch with to this day,” she said. “Jamie Goldfarb was one of the patients I treated. She was newly postpartum, with widely metastatic disease. And I remember her vividly, because she so wanted to be around for her newborn and was so sad she may die. Instead, she miraculously got cured. Now, she’s a melanoma activist and raising awareness about TIL therapy.”

Having seen what TIL could do, Hong said it was impossible for him to turn around and forget about it after his training. He vowed that wherever he ended up — eventually, Cooper in 2018 — he’d create a program dedicated to it. It first earned a few wide-eyed, “What’s that?” responses, he recalls, but Cooper allowed him to launch the program he envisioned.

Recently, Cooper’s MD Anderson Cancer Center in Camden became the first site in the world to offer and enroll a patient in what’s referred to as TILVANCE-301. That’s a Phase III clinical trial comparing the first-line use of TIL to the standard melanoma-fighting immunotherapy, pembrolizumab.

The terminology surrounding the innovation and how it works, which involves the swapping out of depleted immune cells with lab-grown cancer-fighting cells — they’re a mouthful.

But, in short, Hong said this advance is demonstrating potential to prolong the lives of those whose melanoma cancer has spread throughout the body. Research has shown some patients can even be cured of their metastatic melanoma for more than a decade using this new treatment.

In Cooper’s own experience with it, the patient they enrolled in the first-line TIL clinical trial showed a continuous reduction in the size of her tumor, according to a report from the organization late last year.

If there’s a downside, it’s that not everyone is eligible for a clinical trial such as this. Those who had already undergone other treatment for their refractory melanoma wouldn’t be approved for it.

Patients who had already exhausted other treatment options are by far in the majority, however. Those diagnosed with metastatic melanoma typically at least undergo standard monoclonal antibody-based immunotherapy before they seek out novel therapies, Hong said.

That’s why he’s excited about Cooper’s introduction this month of a commercially produced TIL treatment, which received U.S. Food and Drug Administration approval in February for advanced melanoma patients seeking second-line treatment options.

“We expect this to open the doors for a lot of patients … and generally benefit a much wider population,” Hong said. “We even just saw our first patient enrolled in (this program). She had exhausted all her options and referred to TIL therapy.”

It holds promise for those left with few options. Data supports that even patients whose cancer didn’t respond to other forms of treatment still obtain a 34% response rate from TIL therapy, according to Hong.

“TIL still isn’t widely known, and not many know how to deliver it, because there’s a unique toxicity profile that comes with this therapy that you have to anticipate or it can get dangerous,” he said. “We’re going to be the regional TIL center for South Jersey and Philadelphia. There’s no one else in the area giving this. So, we’ll be treating patients from all over coming to see us.

“Patients are already educated and know this is out there. They’re self-referring themselves to us. So, I anticipate us to be very busy.”