Tumor-infiltrating lymphocyte therapy versus ipilimumab in advanced melanoma

Rohaan et al.[1] recently reported improved progression-free survival in patients with advanced melanoma treated with tumor-infiltrating lymphocytes (TIL) versus single-agent ipilimumab. It is pertinent to note that single-agent ipilimumab cannot be considered a standard of care after receiving anti-programmed death receptor-1 (PD-1) therapy.[2] A combination of nivolumab and ipilimumab has demonstrated a higher objective response rate after progression on anti-PD-1 therapy[3] and is possibly a better choice.[4] Furthermore, 43% (73/168) of patients were positive for the BRAF V600E mutation, where the use of a BRAF/MEK inhibitor would have been appropriate.[5] Only 58/162 (35.5%) patients in the TIL arm and 32/82 (39%) patients in the ipilimumab arm could receive any form of targeted therapy on progression. Interestingly, only patients with a lactate dehydrogenase level < twice the upper limit of normal were eligible for TIL treatment, which limits the generalizability of the results to populations with more aggressive diseases. Furthermore, the effect of lymphodepleting chemotherapy on the tumor immune milieu and its effect on the subsequent efficacy of checkpoint inhibitors need to be evaluated. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.