A study shows that a reduced-dose conditioning regimen can make tumor-infiltrating lymphocyte (TIL) therapy safer and more tolerable for older or frail patients with metastatic melanoma.
Researchers cut the cyclophosphamide dose in half while keeping fludarabine at the standard level. Seventeen high-risk patients, aged 66–78, were treated, many with brain metastases or other health issues. Despite the lower dose, the therapy remained effective, with a 44% response rate, similar or higher than standard full-dose trials. Severe side effects, like low platelets, were much less common, and hospital stays were shorter. All patients achieved sufficient lymphodepletion, and all could receive at least one dose of IL-2.
This approach could make TIL therapy accessible to more patients and supports earlier referral after first-line immunotherapy. Future studies aim to validate this strategy and test even less toxic regimens, potentially for outpatient use.