Safe Implementation of Tumor-Infiltrating Lymphocyte Therapy at an Academic Cancer Center: A Multidisciplinary and Oncology Clinical Pharmacy Specialist–Driven Approach

Tumor-infiltrating lymphocyte (TIL) therapy is an emerging autologous cellular immunotherapy with demonstrated efficacy in patients with advanced solid tumors, particularly metastatic melanoma, highlighted by the 2024 FDA approval of lifileucel (Amtagvi). Lifileucel has shown promising clinical outcomes in patients with melanomas following progression on immune checkpoint inhibitors; however, its delivery requires a complex, multidisciplinary care model. Clinical pharmacists play a vital role in therapy coordination, medication safety, and supportive care management, in close collaboration with physicians, nurses, and other health care professionals. Here, we describe the safe implementation of a TIL program at an academic cancer center, with an emphasis on standardized workflows and pharmacy-led safety strategies. Clinical pharmacists developed electronic order sets with embedded safeguards (weight-based dosing, renal adjustment, duplication alerts), conducted drug-interaction screening, and provided patient counseling. Standardized supportive care pathways (antimicrobial prophylaxis, electrolyte replacement, vasopressor guidance) were implemented. Nursing and pharmacy education emphasized early recognition and management of IL-2–related toxicities, with defined monitoring parameters, dose-hold criteria, and intensive care unit (ICU) escalation guidelines.