Patients with leptomeningeal disease (LMD) from melanoma have very poor outcomes and few treatment options. We present a case of intrathecal (IT) administration of autologous tumor infiltrating lymphocytes (TIL) in a patient with LMD from metastatic melanoma. The patient developed LMD after previous treatments with surgery, high-dose bolus interleukin-2 (HD IL-2), and systemic TIL infusion and experienced radiographic progression after intrathecal IL2 (IT IL-2) therapy. The patient received weekly treatment with increasing numbers of IT TIL followed by twice-weekly IT IL-2. The patient received three TIL infusions and did not experience any toxicities beyond those expected with IT IL-2 therapy. Analysis of cerebrospinal fluid (CSF) demonstrated increased inflammatory cytokines following the intrathecal treatments. Subsequent imaging demonstrated disease stabilization, and neurological deficits also remained stable. The patient expired five months after the initiation of IT TIL therapy with disease progression in the brain, liver, lung, and peritoneal and retroperitoneal lymph nodes, but without LMD progression. These results demonstrate the safety of intrathecal administration of TIL in melanoma patients with LMD and support the feasibility of conducting a prospective clinical trial to determine this therapy's clinical benefit among these patients.
- Received March 19, 2015.
- Revision received June 9, 2015.
- Accepted June 15, 2015.
- Copyright © 2015, American Association for Cancer Research.