For the first time, cell therapy has shown its effectiveness against a solid tumor, metastatic melanoma, in a “randomized” trial. This was announced by a Dutch team on Saturday, September 10, at the congress of the European Society for Medical Oncology (ESMO), in Paris.
The 168 participants in the trial were randomly selected to receive either standard treatment for advanced melanoma or this new immune cell therapy. These therapeutic cells are “tumor-infiltrating lymphocytes”, or TILs (“tumor-infiltrating lymphocytes”). So many mini-soldiers naturally trained to recognize and fight cancer cells.
The procedure is complex. The cancerous lesion is first operated on, then cut into fragments. The lymphocytes present are extracted from it. They are cultured and amplified in vitro for several weeks, in the presence of a molecule which stimulates their growth, interleukin-2 (IL-2). Then they are reinjected into the patient.
Two successive treatments
The strategy is not new. Its pioneer, Professor Steven Rosenberg, of the National Cancer Institute, in Bethesda (United States), began to evaluate it in 1988. Why did it take thirty years before a first randomized trial was launched? “TILs are not easy to multiply in vitroanswers John Haanen, of the Netherlands Cancer Institute in Amsterdam, who conducted this trial. In the United States, the National Cancer Institute has never been interested. And we struggled to find centers willing to participate. »
It must be said that the procedure is “heavy and toxicnotes Professor Caroline Robert, head of the dermatology department at Gustave-Roussy (IGR), in Villejuif (Val-de-Marne). This treatment is therefore reserved for patients in very good shape.. The first – non-randomized – trials evaluating this approach therefore suffered from a selection bias.
For the graft of these cells to take, the patient must receive two successive treatments. Prior to TIL reimplantation, he undergoes “conditioning chemotherapy”. The aim is to eliminate another category of lymphocytes, called “regulatory T”, which inhibit these TILs. Then, once they have been reimplanted, this patient is treated with high doses of IL-2 – the same molecule as that used in vitro on these cells – again to promote their multiplication. The procedure, from surgery to discharge from hospital, takes about two months.
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