I wanted to begin this post with a brief update and a moment of gratitude. AdventHealth Orlando has now been activated as an Authorized TIL Treatment Center for Iovance’s lifileucel, also known as Amtagvi, for eligible patients with advanced melanoma. Reaching this milestone in roughly three months has been both meaningful and energizing, especially as I have been learning a new institution, a new culture, and a much larger health care ecosystem. It reflects the extraordinary commitment of many teams across AdventHealth, including pharmacy, nursing, inpatient APPs, surgery, pathology, cell therapy, research, administration, authorization, and our partners at Iovance. These efforts are part of a broader push to expand access to advanced therapies for patients with melanoma and related cancers, including intratumoral therapy, percutaneous hepatic perfusion, and clinical trials. With this foundation taking shape, it felt like the right time to pause and reflect on my own journey with TIL therapy — how I first became involved, why it has remained so important to me, and why expanding access to these treatments matters for the patients and families we serve.
When I look back on my career in melanoma and sarcoma, I sometimes smile at how it all began.
I did not necessarily set out to become “the melanoma and sarcoma person.” Like many young oncologists coming out of fellowship, I was early in my career, still finding my clinical identity, and trying to understand where I could make the biggest difference. Then, in a way that often happens in medicine, opportunity and need intersected. I was asked to take on melanoma and sarcoma.
At the time, melanoma was a very different disease to treat.
For decades, our options were limited. High-dose interleukin-2, or IL-2, was one of the few therapies that could produce durable responses in a small subset of very fit patients. But those responses were uncommon. For many patients, the odds were not where we wanted them to be.
Then came the immunotherapy era.
Checkpoint inhibitors changed the entire landscape. Anti-PD-1 therapy, CTLA-4 combinations, targeted therapy for patients with BRAF mutations, and newer combinations began moving the bar in ways that once seemed impossible. Suddenly, we were seeing patients live longer, respond deeper, and in some cases experience durable control of their cancer.
But for me, one question has always remained the driving force:
What do we do for the other patients?
What do we do when checkpoint therapy does not work?
What do we do when targeted therapy stops working?
What is plan B, plan C, and plan D for the patient sitting right in front of us?
That question is what led me to tumor-infiltrating lymphocyte therapy, or TIL therapy.
Why TIL Therapy Captured My Attention
TIL therapy is based on a powerful idea: sometimes, the patient’s own immune cells have already recognized the cancer. These lymphocytes are found inside the tumor itself. The challenge is that there may not be enough of them, or they may not be strong enough in the tumor environment to fully control the disease.
With TIL therapy, a tumor is surgically removed, immune cells are extracted from that tumor, expanded in very large numbers in a specialized manufacturing process, and then given back to the patient after lymphodepleting chemotherapy. In melanoma, this approach was studied for many years at the National Cancer Institute before it eventually moved toward commercial development.
I remember, years ago, following this field closely and thinking: this can work. We need to find a way to bring this to patients.
At the time, TIL therapy was not commercialized. It was largely available through select academic centers and clinical trials. I was practicing in a smaller, community-based setting — what I sometimes affectionately call “private-demic,” a blend of private practice energy with academic ambition. We were not a traditional academic center. We did not even have a bone marrow transplant program at that time.
But I believed we had the patients. We had the commitment. We had the ability to build the infrastructure. And most importantly, we had the will to try.
So I started reaching out.
Emails. Calls. Follow-ups every few months. The message was simple: we can do this, and our patients need access to this.
Eventually, we were able to open protocols and begin treating patients.
Building a Cellular Therapy Program Before It Was Easy
In the beginning, it was not glamorous. It was hard work.
The patients did not enroll on trial every week. Sometimes it was one every couple of months. But each patient mattered. Each case helped us learn. Each treatment required coordination between surgery, pathology, inpatient teams, nurses, advanced practice providers, pharmacists, research staff, authorization teams, logistics teams, and the clinical trial sponsor.
Over time, we treated more patients. We participated in major studies. We contributed to the registration pathway that ultimately led to FDA approval of lifileucel, now known commercially as Amtagvi, in 2024 for certain adults with unresectable or metastatic melanoma after prior anti-PD-1 therapy and, when appropriate, BRAF-targeted therapy. The FDA described lifileucel as the first cellular therapy approved for unresectable or metastatic melanoma and the first approved TIL therapy.
At one point, during an expanded access period, our site was among the very few open sites — and for a period, we were the only site enrolling and treating patients. I was seeing patients virtually from across the country, helping them navigate whether this therapy might be appropriate, and then bringing them in for treatment.
It was busy. It was nights, weekends, phone calls, and problem-solving.
But it was rewarding because these were patients who often had very few options left.
That is the part of oncology that stays with you. Not the protocol number. Not the meeting schedule. Not the administrative hurdles. It is the patient and family asking, “Is there anything else?”
TIL therapy became one more answer we could offer.
A New Chapter at AdventHealth
After many years of intense clinical work, I took a year away for personal reasons. It was the first real pause I had taken in a long time.
Now, about four to five months after joining AdventHealth, I can honestly say it has been an incredible experience — and a completely different one from what I have done in the past.
I feel energized again.
My focus is melanoma and sarcoma, but now I am supported by a much larger team and a broader cellular therapy infrastructure. AdventHealth is FACT-accredited, and that matters. It means there is a foundation for high-quality cellular therapy work, with the systems, standards, and multidisciplinary support needed to care for patients receiving complex treatments.
Within just a few months of joining, and after many meetings across research, inpatient medicine, nursing, APPs, pharmacy, surgery, operating rooms, pathology, logistics, authorization, and business operations, we were able to become authorized to offer TIL therapy.
That is not a small accomplishment.
It takes a village to deliver cellular therapy. The oncologist may be the visible person in clinic, but this treatment depends on an entire ecosystem. Surgeons need to safely obtain tumor tissue. Pathologists need to process and coordinate specimens. Research teams and cellular therapy coordinators need to track timelines. Nurses and inpatient teams need to manage the expected toxicities of lymphodepletion and IL-2. Pharmacists need to prepare and support complicated regimens. Administrative and authorization teams need to make sure patients can actually access therapy.
When all of that comes together, it is something special.
And now, we can evaluate patients for TIL therapy here in Central Florida and along the coast.
The Expanding Toolbox: TIL, Intratumoral Therapy, PHP, and Beyond
One of the most exciting parts of this new chapter is that TIL therapy is only one piece of a much larger story.
In melanoma, we now think about treatment in layers: checkpoint inhibitors, targeted therapy, cellular therapy, intratumoral therapy, liver-directed therapy for uveal melanoma, bispecific and T-cell receptor-based approaches, and clinical trials combining these strategies in smarter ways.
For patients with metastatic uveal melanoma involving the liver, percutaneous hepatic perfusion with melphalan — HEPZATO KIT — is another important specialized treatment option in selected patients. The FDA approved melphalan as a liver-directed treatment in 2023 for adults with uveal melanoma with unresectable hepatic metastases meeting specific disease criteria.
We also have tebentafusp, a bispecific T-cell engager-like therapy for HLA-A*02:01-positive metastatic uveal melanoma, and ongoing interest in intratumoral therapies such as T-VEC and investigational agents.
I was hopeful that RP1, an oncolytic immunotherapy being studied in melanoma, might become another available tool. Recently, however, the FDA issued a complete response letter for RP1 in combination with nivolumab for advanced melanoma, reflecting a regulatory setback for that approach.
That is part of the reality of oncology research. Some approaches move forward. Some hit setbacks. But the field keeps asking the right question: how do we help more patients benefit?
Why This Work Still Feels Personal
After 14 or 15 years in melanoma and sarcoma, I have come to appreciate how far the field has moved — and how far we still have to go.
When treatments work, everyone is happy. The scans improve. The patient feels better. The family breathes. Those are beautiful moments.
But when treatments do not work, the room feels different. The conversation changes. That is when innovation matters most.
That is why I am excited about TIL therapy. That is why I am excited about modified TIL approaches, T-cell receptor therapies, CAR-T strategies for solid tumors, intratumoral therapies, and trials that may eventually expand these options beyond melanoma into sarcoma and other solid tumors.
I am also excited because I am no longer trying to build this alone. I am part of a team with bone marrow transplant expertise, cellular therapy experience, inpatient support, and institutional commitment. That makes a difference — not just for the physician, but for the patient.
The future of solid tumor cellular therapy will require exactly this kind of teamwork.
Looking Ahead
As I look forward to ASCO and the next wave of clinical trial data, my goal is simple: to be a sponge.
Learn. Listen. Bring back ideas. Open trials. Build programs. Expand access. Do what is best for the patient sitting in front of us.
For me, the TIL journey has never just been about one treatment. It has been about refusing to accept that “no options” is good enough. It has been about building something in places where people may not have expected it could be built. It has been about giving patients access to therapies that once seemed limited to only a few centers.
And now, here at AdventHealth, we get to continue that journey — with more support, more infrastructure, and more possibilities.
There is still a lot of work ahead.
But I am grateful to be back in it.
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. He brings a wealth of expertise to the complex and challenging world of oncology.
Disclosures:
Dr. Thomas serves as a speaker for BMS, Merck, Ipsen, Natera, Immunocore, Pfizer, Sun Pharma, SpringWorks. He also receives industry grants in support of numerous clinical trials.
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