Treatment With Tumor-infiltrating Lymphocytes in Advanced Melanoma

Melanie A. Lindenberg, Valesca P. Retèl, Joost H. van den Berg, Marnix H. Geukes Foppen, John B. Haanen, Wim H. van Harten
2018 Journal of immunotherapy  
Tumor-infiltrating lymphocytes (TIL)-therapy in advanced melanoma is an advanced therapy medicinal product (ATMP) which, despite promising results, has not been implemented widely. In a European setting, TIL-therapy has been in use since 2011 and is currently being evaluated in a randomized controlled trial. As clinical implementation of ATMPs is challenging, this study aims to evaluate early application of TIL-therapy, through the application of a constructive technology assessment (CTA).
more » ... essment (CTA). First the literature on ATMP barriers and facilitators in clinical translation was summarized. Subsequently, application of TILtherapy was evaluated through semistructured interviews with 26 stakeholders according to 6 CTA domains: clinical, economic, patient-related, organizational, technical, and future. In addition, treatment costs were estimated. A number of barriers to clinical translation were identified in the literature, including: inadequate financial support, lack of regulatory knowledge, risks in using live tissues, and the complex path to market approval. Innovative reimbursement procedures could particularly facilitate translation. The CTA survey of TIL-therapy acknowledged these barriers, and revealed the following facilitators: the expected effectiveness resulting in institutional support for an internal pilot, the results of which led to the inclusion of TIL-therapy in a national coverage with evidence development program, the availability of an inhouse pharmacist, quality assurance expertise and a TIL-skilled technician. Institutional and national implementation of TILtherapy remains complex. The promising clinical effectiveness is expected to facilitate the adoption of TIL-therapy, especially when validated through a randomized controlled trial. Innovative and conditional reimbursement procedures, together with the organization of knowledge transfer, could support and improve clinical translation of TIL and ATMPs.
doi:10.1097/cji.0000000000000245 fatcat:6omxzmkrrvfdtmk3an7klkxiqa