It was not the news that Pattie Fuller wanted to hear.
Doctors at a local hospital in upstate New York told her that despite surgery and several rounds of immunotherapy, her melanoma was growing. The melanoma ultimately grew to be stage 4. It spread from her scalp to the lymph nodes in her neck, her liver, and her lungs.
“Early on, I told my oncologist that if we ever got to the point where he couldn’t help me anymore, I wanted him to refer me to someone who could,” Pattie remembers. Her doctor eventually suggested she go to Memorial Sloan Kettering Cancer Center (MSK) for a second opinion. There she met with melanoma medical oncologist and cellular therapist James Smithy, MD, MHS.
Getting the Latest Stage 4 Melanoma Treatment at MSK
Dr. Smithy told Pattie about tumor-infiltrating lymphocyte (TIL) therapy, a new type of immunotherapy for treating melanoma that was approved by the U.S. Food and Drug Administration (FDA).
Today, more than a year after receiving the TIL therapy, the tumors in Pattie’s lungs and liver have completely disappeared. The ones in her lymph nodes have shrunk dramatically. Now 46, she is engaged to be married and has returned to her job, where she provides supportive services to people with special needs.
“I was so happy when I got the scans showing that the treatment was working,” Pattie says. “I’m grateful for MSK, because I feel like no one there ever gave up on me.”
From Upstate New York to NYC: Finding the Right Melanoma Treatments Remotely
When Pattie first came to MSK for care, Dr. Smithy prescribed an immunotherapy combination and then a combination of immunotherapy and targeted therapy.
Pattie also was treated by MSK endocrinologist Lubaina Presswala, DO, for an adrenal insufficiency that was caused by her earlier immunotherapy treatments. Dr. Presswala specializes in managing many of the side effects of immunotherapy.
Because Pattie lives nearly a five-hour drive from New York City, Dr. Smithy coordinated her cancer treatments with her local oncologist, so that Pattie only needed to travel to MSK occasionally for scans.
When the targeted therapy and immunotherapy were no longer enough to stop the melanoma from spreading, Dr. Smithy told Pattie that TIL therapy, which is given as a one-time treatment, was likely her best option.
TIL Therapy Is a New Melanoma Treatment Option
TIL (pronounced “till”) therapy works by taking advantage of white blood cells called tumor-infiltrating lymphocytes, a type of immune cell found inside tumors. Because these cells have already penetrated the tumor, they can be harnessed as a strong force in the fight against cancer.
TIL treatment involves removing the immune cells from a patient’s tumor, then growing them in a lab to multiply the fighting force. When it’s time to infuse the cells into the blood, patients first get chemotherapy to tamp down their immune systems and prepare them to receive the legion of targeted immune cells.
MSK’s Expertise With Lifileucel TIL Immunotherapy
Pattie received a TIL treatment called lifileucel (Amtagvi®), which was approved by the FDA as the first cell therapy to treat solid tumors. MSK conducted clinical trials to provide evidence for the FDA approval, and since then MSK has treated about two dozen patients with the lifileucel TIL therapy. Doctors at MSK have extensive experience with TIL and other cell-based therapies, including knowing how to manage their side effects.
The Process of Receiving TIL Therapy for Stage 4 Melanoma Treatment
To collect Pattie’s TIL cells, MSK thoracic surgeon Matthew Bott, MD, performed minimally invasive (laparoscopic) surgery to remove a small metastatic tumor from the lower lobe of her right lung. This provided the immune cells that would be grown and used to provide the TIL treatment.
Dr. Bott says the surgery was challenging and almost had to be canceled because of the side effects Pattie was experiencing from her earlier treatments.
While Pattie waited for the TIL cells from her tumor to be grown, she went home for about a month. “I was feeling hopeful about getting the TIL treatment,” she says.
When the army of cancer-fighting immune cells was ready, she returned to the city for treatment. Pattie says it was relatively easy for her and that she didn’t have many side effects, except for one day when she developed severe chills. She spent about a week in the hospital after getting her TIL therapy.
After discharge, she had to remain close to MSK for several weeks for frequent follow-up visits. MSK social worker Maya Ramos, LMSW, arranged for Pattie to stay in a furnished apartment at MSK’s East 75th Street Patient Residence until she was able to go home.
MSK also arranged to have a caregiver stay with her at the apartment. “I was never alone,” she says. “They made sure I always had someone there with me.”
“The whole MSK team was wonderful, so friendly and supportive,” Pattie adds. “They took such good care of me throughout my recovery. They also helped me with financial support, including housing and transportation costs while I was in treatment.”
MSK Genetic Testing Revealed an Inherited Cancer Gene: Lynch Syndrome
During Pattie’s treatment, tests revealed something else: She had inherited a gene for Lynch syndrome, a hereditary disorder that is linked to an increased risk of several types of cancer, including colorectal cancer and uterine (endometrial) cancer in addition to melanoma. Pattie’s father, who died of colorectal cancer many years ago, likely carried the gene as well.
Now, as part of her follow-up care, Pattie will get regular screenings — including colonoscopies — for other cancers linked to Lynch syndrome. She has told her family members about this inherited risk so that they can get tested as well.
She also tells everyone about the care she got at MSK. “I share my melanoma survival story with anyone who will listen,” Pattie says. “I tell them that if, God forbid, they ever get cancer, MSK is the place to go.”
