Amod Sarnaik, MD, and Krishna Komanduri, MD, share their clinical experience with, and practical advice on, tumor-infiltrating lymphocyte therapy for their patients with solid tumors.
Amod Sarnaik, MD: The next item to discuss is our experience with TILs [tumor-infiltrating lymphocytes] in clinical trials, and how to improve communication with clinicians outside the clinical trial when using TIL.
Krishna Komanduri, MD: The key thing is understanding how to coordinate routes of care. We learned a lot in the CAR [chimeric antigen receptor] T-cell setting. As we move from third-line therapy in the setting of lymphoma to second-line therapy, where we need the patient to be referred to a tertiary center, we need to think about whether CAR T-cell therapy is important. Some of those rules will also apply to the TIL setting. We need to develop areas of crosstalk. In the CAR T-cell setting, we developed approaches to have pulmonologists, neurologists, and ID [infectious disease] doctors working closely with medical oncologists or hematologists to administer CAR T-cell therapies. Here there’s the added complexity of making sure that we have coordination between the surgical team and the medical oncology team, and these are things that are unique.
We’d like to make sure we have broad utilization of these therapies for the patients who deserve to have access to them. I applaud the companies in this space for working on approaches to proactively educate individuals about infrastructure outside the clinical trial setting. We don’t want to get to a situation in which we have therapies approved for patients—especially those who failed frontline therapies—that are available, and then we have issues of suboptimal referral or suboptimal coordination within centers. You and I are fortunate to work in centers that have broad experience in immunotherapies, not only commercial immunotherapies but also therapies being developed in house. We’re further along the learning curve, and it’s important that we continue to do things to make sure individuals are comfortable. That’s largely the case.
The good thing is that we have a great cohesive and collaborative milieu in which we work—melanoma and dermatology and surgical oncology, as well as medical oncology and hematology. It’s going to take some effort. One lesson we learned from CAR T-cell therapy is that too few patients who can benefit from these therapies are getting them. Even 5 years after of approval of breakthrough CARs, less than half the individuals who qualify according to the label are getting them. We want to make sure we don’t see the same underutilization of these therapies when it comes to TILs, knowing that there are unique aspects of coordination of team building that are required.
Amod Sarnaik, MD: I’m proud to say that you and I are members of this TIL working group. It’s a national consortium of individuals in academia. Sometimes it’s hard to get all of us to play together in the same sandbox. It’s an excellent collegial environment that helps get the word out and improve awareness, as well as forums such as this 1. OncLive® is watched by many individuals, and this is going to improve awareness of this promising treatment modality.
Krishna Komanduri, MD: That’s absolutely true. We’re learning from each other as we go along. That’s critical as we help our patients.
Transcript edited for clarity.