CURE staff

TIL therapy is on the rise in melanoma, with potential for other tumor types.

Katie Ortman Doble was 31 years old when she was diagnosed with ocular melanoma, a rare type of cancer that originates in the eye, in May 2013. Since the cancer was contained to her eye, she underwent plaque therapy, a type of radiation therapy, and a biopsy to assess the disease further.

“I received a phone call a few weeks later letting me know that my cells were the best-case scenario,” Doble, now 43 and living in Denver, tells CURE. “They were classified as 1A, which meant there was a less than 2% chance that they would ever spread. So, I thought that was it.”

Her doctor advised Doble to undergo imaging every six months. Doble had clear images in April 2014. But in November 2014, imaging showed that there were at least 12 suspicious lesions on her liver. A biopsy needed to be done immediately.

The biopsy confirmed that she had stage 4 incurable cancer, and her oncologist told her she had 16 months to live. With limited options based on her disease’s genetic makeup, Doble’s father helped her find a clinical trial to participate in. This led Doble, her father and her fiancé across the United States to participate in multiple clinical trials and traditional therapies from January 2015 to mid 2018. She was eliminated from each trial due to side effects or tumor growth, but liver embolization, which is only Food and Drug Administration (FDA)-approved for metastatic colon cancer, stabilized her liver for several years.

After tumor growth in her liver was noticed in June 2020, she was connected with a doctor at the University of Pittsburgh Medical Center’s Hillman Cancer Center, who was conducting a trial in tumor-infiltrating lymphocyte (TIL) therapy.

“The way that the doctor described it was that he was essentially going to wipe out my immune system with chemotherapy, like you would wipe out a computer, then you reinstall the programs. He was then going

to reinstall this cancer that was taken out of my body and programmed like a robot to go back in and attack itself,” Doble says.

Doble underwent tumor banking in July 2020. The TILs were manufactured, and she underwent preparatory lymphodepleting chemotherapy, TIL infusion and high-dose interleukin-2 (IL-2) in September 2020.

“Every scan that I had, we were seeing really, really good results,” Doble says. “My doctor — he kept calling it a bumper crop of cells, like I had one of the largest batches of cells he’d ever grown before.”

Some tumors were disappearing, Doble adds, but one tumor on her liver kept growing. So, in September 2021, she and her husband flew back to Pittsburgh to have half of her liver removed.

“I woke up from that surgery, [my husband] Nick was sitting in the corner, and he was like, ‘He got it all. You have no evidence of disease,’” Doble recalls. 

“It was a miracle day. I have had no evidence of disease for over three years now.”

Amtagvi (lifileucel) was the first TIL therapy approved by the FDA, in February 2024, for the treatment of patients with advanced melanoma whose disease progressed on or after anti-PD-1/PD-L1 therapy and targeted therapy.

“In the past, we only had immunotherapy and targeted therapy as standard options for these patients,” Dr. Sunandana Chandra, associate professor of medicine at Northwestern University Feinberg School of Medicine in Chicago, says in an interview with CURE. “Now we have not only another option, but an option that is very different from the existing approved regimens for metastatic melanoma.”

Chandra adds that this new treatment still has benefits and risks associated with it.

“The upside with TIL therapy is that it’s this novel, first-in-its-class approval [for] metastatic melanoma, where we’re using the patient’s own immune cells against the cancer,” she says. “The downside of TIL therapy is that it’s a rigorous regimen. It requires a huge commitment

from the patient. It is only able to be given in a very limited number of sites across the country.”

Another barrier to TIL therapy is the cost. According to a post on the National Cancer Institute’s website, the manufacturer of Amtagvi noted that a single treatment would cost $515,000, although the company said that financial assistance programs will be established for patients.

“[TIL therapy] is a therapy that, if it is effective, it’s a one-time treatment,” says Dr. Adam J. Schoenfeld, thoracic medical oncologist, and cellular therapist and early drug development specialist at Memorial Sloan Kettering Cancer Center in New York. “So, you don’t have to have repeated treatments down the road.”

Patients who may be eligible for TIL therapy are those with advanced melanoma whose disease either progressed on or responded poorly by way of side effects to PD-1 antibody-based therapy, predominately Opdivo (nivolumab) or Keytruda (pembrolizumab). Given the rigor of TIL therapy, patients whose tumors have BRAF mutations are required to have disease progression after targeted inhibitor therapy prior to TIL therapy since targeted inhibitor therapy is less rigorous for patients.

Performance status is another assessment that is taken into consideration when determining whether a patient is a candidate for TIL therapy. This status factors in how functional a person is in their daily life, strength, time spent out of bed or a chair, and daily activities, among other factors. Care teams also assess each organ’s function — particularly the kidneys, heart and lungs.

Once a patient is considered eligible to undergo TIL therapy, the first step is surgery, during which a piece of the tumor is removed to obtain the material needed to make the T cells.

After tumor resection, the patient can return home, and the manufacturing period begins for the TIL product, which is done in an off-site facility. During this time, a patient may undergo bridging therapy or another treatment.

“In the lab, that tumor specimen that was obtained from the patient is then essentially chopped up, and the patient’s own T cells are extracted from it,” Chandra says. “Those T cells have been grown in the lab [and] — about three to four weeks later — are ready to be infused back into the patient.”

Before the TIL cells are infused, the patient undergoes lymphodepleting chemotherapy for five to seven days.

“Normally, we think about chemotherapy as a way to kill rapidly growing cancer cells,” Schoenfeld says. “But here, we’re actually using chemotherapy as a way to reset the clock on your immune system and create space for the TIL to grow when we infuse the TIL.”

After the lymphodepleting chemotherapy is completed, the patient receives the
TIL infusion in the hospital through a vein. During this time, experts say that patients receive up to a trillion T cells that were grown in the laboratory. A patient undergoing TIL is then closely monitored by their care team.

Following that, the patient is treated with high-dose IL-2, boosting the immune system in cancer therapy. This regimen is administered for up to six doses and may take a few days to complete.

“This [IL-2] is what is used to grow the TIL,” Dr. Amod Sarnaik, professor of cutaneous oncology and immunology at Moffitt Cancer Center and the University of South Florida in Tampa, Florida, tells CURE. “So, the thought is that if you just give the TIL without the [IL-2] ... that abrupt withdrawal may cause some problems for the TIL because they’re used to being grown in the high concentration of the [IL-2].”

This entire process, from tumor harvesting to completion of high-dose IL-2, experts say, can take between six and eight weeks. Toward the end of the process, usually after receiving high-dose IL-2, a patient can be discharged home if deemed appropriate. The patient then undergoes subsequent scans in an outpatient setting for care teams to determine whether the TIL therapy had an effect on the cancer.

Jamie Troil Goldfarb, now a 47-year-old living in Takoma Park, Maryland, with her husband and 14-year-old son, was diagnosed with stage 2B melanoma in 2007. The 32-year-old, at that time, underwent surgery to remove it, and a sentinel lymph node biopsy showed clear results. After Goldfarb experienced several infections, her oncologist called the surgeon and urged him to investigate further to see whether a suture was left behind. During that surgery in December 2009, it was discovered that she had stage 3 melanoma, for which a wait-and-watch approach was suggested.

In January 2011, three months after Goldfarb gave birth to her son, Kai, her oncologist recommended she undergo a scan before she returned to work from maternity leave. That is when she learned that the cancer had metastasized to her liver and pancreas, marking her disease as stage 4, and her care team gave her a 15% chance of survival.

With her experience in patient recruitment for a company that conducted clinical trials, she knew immediately to look for options. She found a study assessing TIL therapy in melanoma, for which she was eligible.

Compared with the FDA-approved regimen with Amtagvi, Goldfarb received four full rounds of IL-2 before receiving the lymphodepleting chemotherapy and then the TIL infusion in September 2011. This TIL infusion was somewhat different from Amtagvi, as researchers took Goldfarb’s cancer cells and genetically engineered them to express IL-12 upon contact with the tumor.

Initially, months after the infusion, scans showed that her tumor was growing, which led the research team to consider other treatment options, although Goldfarb was not ready to do that. “I was very emotionally [invested in] this really intense clinical trial for TIL and then being cured,” she recalls.

In January 2012, her scans started to show that the tumors were shrinking.

“All of the tumors shrank over the next two years until I had no evidence of disease, and it’s been 12 years now, completely disease-free,” Goldfarb says. “My diagnosing physician told me that he would do everything in his power to buy me six months with the baby, and [Kai] just turned 14 last week.”

Most of the side effects of this regimen may be associated with the lymphodepleting chemotherapy before the TIL infusion and the high-dose IL-2 after the infusion.

“I got a rash from the chemotherapy, and I couldn’t take steroids,” Doble recalls. “That was really uncomfortable. The TIL experience, it was a 22-minute infusion. It was totally uneventful. And then once the IL-2 hit, that’s when it kind of went downhill. ... [My doctor] was thrilled that I felt like s---. He’d come in and he’d be like, ‘This is good, Katie. This is so good because it means you’re responding.’”

Side effects associated with Amtagvi, according to the FDA, include fever, chills, tachycardia (abnormally fast heart rate), fatigue, febrile neutropenia (fever with a low level of certain white blood cells), diarrhea, rash, edema (swelling from fluid buildup in tissues), low blood pressure, infection, hair loss, shortness of breath and abnormally low oxygen levels.

“The TILs are designed to attack the tumor, but remember, the tumor came from our own cells, so the tumor and normal tissues sometimes share similar targets,” Sarnaik says.

Goldfarb mentions that she got vitiligo as a potential result of the TIL therapy, but other than that, she did not experience any other long-term side effects.

“I got [vitiligo] as an initial side effect around my neck,” she says. “And then five years ago, it [spread]. ... So now it’s everywhere, which is fine. ... I’d rather have vitiligo than cancer.”

With the high-dose IL-2, experts say that side effects can be “somewhat profound in the short term,” Schoenfeld says. This response, he adds, is because IL-2 stimulates the immune system, so it may cause shaking chills, fever, capillary leak syndrome (when fluid leaks outside of blood vessels and into legs and arms), and fluid around the lungs, causing shortness of breath.

Experts say that after a month or couple months after receiving TIL, patients typically regain their strength.

Melanoma was one of the first cancers to be assessed in TIL therapy trials because of how heavily mutated it can present, experts say. Researchers are currently seeing whether TIL therapy can derive similar success in cancers that are also heavily mutated, such as lung cancer.

Studies are also focusing on the potential of TIL therapy in cancers caused by viruses, such as cervical cancer and head and neck cancer. Experts note that cancers with unstable DNA repair mechanisms, such as colorectal cancer, may also see success with TIL therapy. Research is also aimed at assessing TIL therapy in patients with aggressive cancers with minimal treatment options, such as gastrointestinal malignancies and sarcoma.

In addition to assessing the potential benefit of TIL therapy in other cancer types, researchers are aiming to see how TIL therapy itself
can be improved and expanded. For example, researchers are seeing whether there are more effective ways to manufacture TIL, such as identifying TILs that could be expanded or engineering TILs to make them more active. Additionally, researchers are investigating whether there is a way to manufacture TILs so they have other properties to potentially eliminate the need for chemotherapy before or high-dose IL-2 after the treatment.

Goldfarb says she “screams the praises of TIL every chance I get.”

“Every time [my son, Kai,] has a birthday, I think about how lucky I am that I get to see it,” she says.

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Articles

Ocular melanoma patient Katie Ortman Doble's journey highlights the potential of tumor-infiltrating lymphocyte (TIL) therapy in treating advanced melanoma. Despite initial setbacks, Doble achieved no evidence of disease after undergoing TIL therapy, which involves using a patient's own immune cells to target cancer. The FDA approved Amtagvi (lifileucel) as the first TIL therapy for advanced melanoma in 2024. While promising, TIL therapy is rigorous, costly, and limited to select sites. Research is ongoing to expand TIL therapy's application to other cancer types and improve its efficacy.

Empowering the Immune System

Cancer touches everyone — cutting across religion, race, ethnicity, sexual orientation and socioeconomic status: © stock.adobe.com.

Cancer is nonpartisan. It touches everyone — cutting across religion, race, ethnicity, sexual orientation and socioeconomic status. As a community, we fight to prevent, diagnose, treat, cure and grieve this “Emperor of All Maladies.” There is, and will continue to be, tremendous hope and opportunity in the field of oncology, fruits reaped by the long-standing commitment and investment in scientific discovery.

The funding landscape for cancer research is complex, with multiple stakeholders invested in improving outcomes. There is an intricate woven mix of federal, state and private resources set up to study and fight cancer. The National Institutes of Health (NIH) and the National Cancer Institute (NCI) are by far the largest federally funded mechanisms that exist to combat cancer. You and I, taxpayers, are the largest funders of health and research in the United States.

In 1971 the National Cancer Act, an amendment to the Public Health Service Act of 1944, led to the establishment of the NCI, officially declaring our “war on cancer.” The act granted broad authority to the director of the NCI and significantly increased funding to academic research institutions. Private institutions, foundations and pharmaceutical companies also play a critical role in this battle and, together with federal funding, have led to significant improvements in outcomes and overall survival for people diagnosed with cancer. NIH and NCI funding contributed to 99% of therapies approved between 2014 and 2019, and ongoing advances will likely contribute to the future of cancer care in America and globally.

The fiscal year 2026 budget proposes a \$17.5 billion cut to the NIH, including the NCI, amounting to a 37% cut in funding. We cannot accept this! Our community of scientists, clinicians, patients and caregivers cannot allow a climate of fear and budget cuts to slow down discovery. In a recent powerful letter to the American people, scientists spanning the political spectrum representing the nation’s top medical and scientific researchers, including Nobel laureates elected members of the National Academies of Sciences and Medicine, wrote that “… the voice of science must not be silenced. We all benefit from science, and we all stand to lose if the nation’s research enterprise is destroyed.” Cutting funding for critical cancer research, including clinical trials, would destroy this great enterprise that is baked into the fabric of our country. Rapid changes and cuts to the infrastructure of the Food and Drug Administration risk slowing down the approval of novel therapies for patients in waiting. We need to act rationally and swiftly to urge our elected officials to change course and continue to fund the critical work that will continue to lead to discovery and cure.

As I sit with a young woman who newly diagnosed with stage 4 lung cancer, she asks me if there is hope: “How will our current landscape of budget cuts, fear and skepticism affect my outcome?” I tell her that I don’t know, but I promise her that we will do everything in our power as a community to allow her to live well and with a focus on quality and dignity of life.

For the readership of CURE, please understand that basic science research may be under fire, but the practice of oncology has not changed. Clinics are functioning as usual. Clinical trials are functioning as usual. Treatment, progress and cure are still within reach.

Martin Luther King Jr. said, “The arc of the moral universe is long, but it bends towards justice,” so too is scientific progress — the discoveries of tomorrow are fundamentally entrenched in the investments we make today. Despite the current landscape of research funding, there is a tremendous amount of hope and ongoing opportunity for progress today.

Cancer affects all demographics, and the fight against it involves prevention, diagnosis, treatment, and research. The funding landscape for cancer research is complex, involving federal, state, and private resources, with the NIH and NCI being major contributors. The proposed 2026 budget cuts to the NIH threaten progress in cancer research and treatment. Despite these challenges, the oncology community remains committed to advancing care and maintaining hope for patients. The practice of oncology continues, with clinics and clinical trials operating as usual, emphasizing the importance of sustained investment in scientific discovery.

Cancer is nonpartisan. It touches everyone — cutting across religion, race, ethnicity, sexual orientation and socioeconomic status.

Funding for Cancer Research: Hope in a State of Fear

A significant development in the treatment of advanced melanoma has recently emerged: © stock.adobe.com.

A significant development in the treatment of advanced melanoma has recently emerged: tumor-infiltrating lymphocyte (TIL) therapy, a novel approach harnessing the power of a patient’s own immune system. In 2024, a first-of-its-kind drug was approved by the Food and Drug Administration (FDA) for patients whose cancer has progressed after other treatments.

In this issue of *CURE*, we highlight the details of this groundbreaking treatment, explaining how it differs from traditional immunotherapy and targeted therapies. You’ll learn about the steps involved, from tumor removal and T-cell manufacturing to the infusion process and the role of high-dose interleukin-2 in boosting the immune response, as well as crucial postinfusion care.

While TIL therapy presents a promising new avenue, it’s important for patients to understand both its potential benefits and its challenges. A key advantage is that it’s designed as a one-time treatment, potentially offering a lasting response without the need for continuous therapy. However, the treatment is rigorous, requires a substantial time commitment and is currently available only at a limited number of medical centers. Additionally, the cost of TIL therapy is significant, although financial assistance programs are being explored.

You’ll hear from experts who dive into this exciting advancement, as it offers a personalized and potentially impactful approach for patients who have limited options. Further, as research continues, this innovative strategy may hold promise for other cancers as well, expanding the arsenal of tools available in cancer care.

Also in this issue, we recognize our 2025 Extraordinary Healer® award winner, Kaifan Zhao, AGACNP-BC, PMHNP-BC, for his dedication to making a difference in the lives of patients and their loved ones. The event, held during the 50th Annual Oncology Nursing Society Congress, also featured a keynote lecture from journalist, podcaster and author Amy Robach. “You are walking with \[patients with cancer] during the scariest time of their lives,” she said. “They are afraid for their lives. They are afraid to think about tomorrow. They’re fighting for tomorrow, and you are there as their backbone, as their support, as their light,” she said.

If you are inspired by the testaments shared by our Extraordinary Healer finalists, essay nominations for the 2026 award ceremony are now open on curetoday.com. It is with your nominations that we can recognize the amazing feats of our oncology nursing community.

Staying informed is a powerful tool in your cancer journey. For the very latest updates in oncology, including breaking news on FDA approvals and expert perspectives on key cancer information, turn to curetoday.com.

We are dedicated to ensuring you have the information you need to navigate your cancer experience with clarity. Within these pages and on our website, you’ll find both personal narratives that resonate and expert opinions that provide context. We hope this information serves you well and offers encouragement. Thank you for your continued readership.

Tumor-infiltrating lymphocyte (TIL) therapy represents a significant advancement in advanced melanoma treatment, utilizing a patient's immune system. The FDA approved a pioneering drug in 2024 for patients with treatment-resistant cancer. TIL therapy, distinct from traditional immunotherapy, involves tumor removal, T-cell manufacturing, and infusion, with high-dose interleukin-2 enhancing immune response. Despite its promise, TIL therapy is rigorous, costly, and limited in availability. The approach offers a personalized treatment option, with potential applications in other cancers. The issue also highlights the 2025 Extraordinary Healer® award and encourages essay nominations.

A significant development in the treatment of advanced melanoma has recently emerged: tumor-infiltrating lymphocyte (TIL) therapy.

A New Frontier in Melanoma Treatment

How artificial intelligence is being used to augment the work of experts treating patients with prostate cancer.

For patients with prostate cancer, artificial intelligence (AI) appears to be en route to becoming a key part of the cancer journey, as experts who spoke to CURE explain.

“Right now, AI is definitely being folded into different levels of the entire journey for patients,” says Dr. Soroush Rais-Bahrami of Wake Forest University School of Medicine in Winston-Salem, North Carolina.

AI caught attention at the annual meeting of the American Urological Association, held in April in Las Vegas, where data were presented from a UCLA-led study showing that AI-generated cancer mapping was able to accurately predict seminal vesicle invasion (SVI), or the spread of cancer cells from the prostate gland into a patient’s seminal vesicles. 

“AI-generated cancer mapping accurately predicted SVI, despite never being specifically trained for this task. AI dramatically improved upon the SVI predictions of MRI, with the potential to support early diagnosis and treatment of invasive [prostate cancer],” wrote researchers, including Dr. Wayne Brisbane, an assistant professor of urology at UCLA Health, in study findings published in the Journal of Urology.

As Dr. Nitin K. Yerram, director of urologic oncology at Hackensack University Medical Center in New Jersey, explains, the technology’s potential utility in prostate cancer care and management is ever-evolving.

“This role, it’s relatively new over the [past] few years, and it just keeps changing every day,” Yerram says.

“But there [are] two main places that I think AI is used more on a day-to-day basis: one of them is more a diagnosis, and the other one is treatment stratification.”

Regarding diagnosis, Yerram says AI is now sometimes used to read an MRI of a patient’s prostate in order to understand whether there are potentially suspicious areas of the organ.

“That’s going to be prime time in the next few years,” he says, “but what it’s currently being used in right now is, when you do a biopsy — and these slides are sent to a pathologist — [AI] is augmenting the pathologist and helping them determine the areas that need further investigation. ... So it’s really making the pathologist more accurate as well as probably more efficient.”

Concerning treatment stratification, Yerram explains that when a man is diagnosed with prostate cancer, he is placed into a category of low, interme-diate or high risk. “Based on those categories, we’re able to either offer them surveillance for low-risk patients — because that cancer is really slow-growing and probably not going to be a major issue in their lifetime — or, for high risk, we’re saying, ‘Hey, we need maybe surgery or radiation, or maybe both.’

“... Now we’re actually using [AI], and ... they’re able to now look at that slide and understand very minute patterns over a course of many slides, or all the tissue that pathologists probably can’t really perceive but a machine learning algorithm never forgets, [and it] can really understand and see those patterns and can help decipher a little bit more of what is high risk, what is low risk, maybe what’s intermediate risk.”

Such work, Yerram explains, is currently being done by the team at Artera via its ArteraAI Prostate Test, for example.

“We’re able to send the patient’s tissue to this company, and they’re able to scan the whole slide and be able to give us an output saying, ‘Hey, this patient is probably low risk,’ or maybe it’s high risk, or maybe it’s intermediate risk. So, we’re able to further identify patients and stratify them better to help make treatment decisions.”

In the realm of treatment, Yerram says machine learning algorithms are playing a role, for example, by making robotic surgery more efficient and less harmful for patients in order to effectively treat cancer and improve functional outcomes after surgery.

“You know, not everyone needs surgery,” Yerram adds. “We have different options, including ultrasound ablation ... and AI is able to help us determine, when you have a whole prostate and you want to just treat one certain area, how we can use [AI] to find that area, give a good treatment margin [and] help us determine what the most effective treatment course [is]. It’s helping the physicians augment that treatment pattern, and I think we’re going to be able to see leaps and bounds of improvement in this area for the years to come.”

However, questions and issues remain, as researchers note.

“The long-term success of AI in prostate cancer depends on our ability to solve multiple challenges spanning ethical, legal, regulatory and technical realms,” wrote Dr. Irbaz Bin Riaz, of the Mayo Clinic in Phoenix, and colleagues in the 2024 American Society of Clinical Oncology Educational Book. “Critical issues include protection of the privacy of the patients’ data, liability management between the [mistakes and biases] that can come with the AI systems, and the interpretability and adaptability deficit of the AI systems with respect to current clinical workflows.

“The effectiveness of the AI models depends highly on the quality and diversity of the training data; therefore, models often do not have their intended effect across different hospitals and healthcare systems settings because of data limitations. Additionally, there is concern about healthcare providers potentially over-relying on AI, which might diminish the value of human clinical judgment and intuition. The absence of standardized AI guidelines, coupled with high deployment costs and fears about job security and loss of professional autonomy, further complicates AI adoption in clinical practice.”

“Right now, [AI] has a complementary role, as far as it can make our jobs easier and [make] sure that things are not falling through the cracks,” says Richard Boyajian.

An advanced practice registered nurse and nurse practitioner in the Department of Radiation Oncology with the Dana-Farber Brigham Cancer Center in Boston, Boyajian founded the Virtual Prostate Cancer Clinic at Brigham and Women’s Hospital in 2016.

He is also a member of the CURE advisory board.

“The quicker you can present all the data succinctly to the provider, they’re able to make a decision based on these multiple points that should be considered,” Boyajian says. “If you don’t present all of it, it’s human nature to ... [say], ‘OK, I know we need to focus on [prostate-specific antigen]. We need to focus on what’s going on ...’ But there may be other things that are in play that AI can calculate to build the picture so we can put whatever’s going on into a context, if you will.”

Aside from skin cancer, prostate cancer is the most common cancer among men in the United States, with the American Cancer Society estimating that there will be approximately 313,780 new cases of prostate cancer in the United States in 2025. Incidence rates of the disease have increased by 3% per year since 2014, and approximately 1 in 8 men will be diagnosed with prostate cancer in their lifetime.

“With prostate cancer, we’re going to cure, what, 90% of these guys? They’re the biggest male population of cancer survivors in the world, in the country,” Boyajian says. “So, if you think of what’s going on now ... we’re being asked to
see more people than humanly possible in a certain time frame. It gets overwhelming because the human mind can’t process everything quick enough.”

Boyajian says he is now working with Cancer Insights on a National Cancer Institute grant to use their AI platform to understand what phase of care
a patient is in based on medical records data, with eventual plans to develop monitoring modules for each phase of care.

“It will make most of my colleagues’ lives infinitely easier, especially in the survivorship and follow-up community,” he says, “because we’re just drinking at a fire hose right now, where there [are] just so many patients.

“The other thing I worry about is [that] our human structures are breaking down. I’m not in love with AI, don’t get me wrong, but I’m seeing more and more that humans are fallible, and when you overwhelm the healthcare system — like it seems like it is now — there’s a lot of stuff falling through the cracks. And in other businesses, that might be acceptable, but falling through the cracks here means there’s a patient [who] hasn’t got an answer on something, stressing out of their mind, wondering, ‘What’s happening? Are they just letting me die?’ or things like that. That’s the communication issue and ... we need to find ways around it.”

When it comes to treating the prostate, Brisbane explained in a 2024 interview with CURE that precision is key.

“There are some very important factors that run in and around
the prostate,” Brisbane said. “One is the urethra, and the others are the neurovascular bundles, which are like telephone wires from the brain to [the] phallus, saying it’s time for an erection, and those are running right alongside the prostate. The bladder is right behind the prostate, and then there are the pelvic floor muscles, which are responsible for urinary continence and fecal continence, right at the apex of the prostate or the nose of the prostate.

“The prostate is kind of... high-stakes real estate, so where the tumor is relative to all those structures really indicates what kind of side effect profiles patients are going to experience when they’re getting treatment. So, knowing that with accuracy is very important to know [when asking], ‘Can we treat this cancer?’ or ‘How do we treat this cancer best while minimizing side effects?’”

Tumors, Brisbane explained, are shaped like crabs, in that they have a central body as well as “a lot of legs that go out beyond the portion [of the tumor] that is visible on imaging, and that’s true for all imaging modalities [such as] MRI, [prostate-specific membrane antigen] and these newer imaging modalities like microultrasound.”

As of late, Brisbane has been utilizing the cancer-mapping tool Unfold AI.

As explained by AI health care company Avenda Health, Unfold AI “combines patient-specific data from prostate imaging, biopsies and pathology into deep learning algorithms to create a unique and tailored cancer estimation map. Its 3D, AI-generated map visualizes the location of the cancer for physicians to use in treatment decision-making and interventional planning.” It was cleared for use by the Food and Drug Administration in late 2022, according to Avenda Health.

Brisbane and his colleagues have utilized Unfold AI to support the use of precision medicine (also known as focal therapy) to treat cancer with the TULSA procedure, or TULSA-PRO, which uses ultrasound to create high temperatures and destroy prostate tissue.

“The use of AI is certainly building and only becoming more augmented,” Rais-Bahrami says. “As we move forward, there’s definitely going to
be an important role for AI in a lot of the processes we use, and I would say ... the diagnostic and treatment decision-making journey for patients with prostate cancer, we have yet to see where it’s going to land, but I certainly see it developing [and] becoming more commonplace.”

Rais-Bahrami is the William H. Boyce Endowed Chair in Urology and Professor and chair in the Department of Urology at Wake Forest University School of Medicine. He is currently using the Unfold AI tumor mapping tool retrospectively to compare its accuracy to diagnosis without AI assistance.

“Specifically, with Unfold AI, it’s integrating the inputs from patient demographics, clinical parameters and patient imaging — so the primary imaging from prostate indication, pelvic MRI, multiparametric MRI input [and] the pathology output from biopsies that we get,” Rais-Bahrami says. “It’s giving us cancer estimation maps that have been very valuable in my practice to scale the degree of radical prostatectomy surgical planning, [as well as] planning for focal therapy patient candidates.”

Rais-Bahrami also explained that the use of AI can help level the playing field, so to speak, for patients and providers. “Understanding each clinical case and personalizing treatment algorithms, decision-making [and] patient counseling is going to be key, and that’s where the nuances of AI will most likely normalize some of the personalization that was largely based on clinician and provider expertise,” he says. “AI is taking huge data sets of input with deep learning and machine learning, whereas that would take an entire generation of learning, a senior practitioner and a senior urologist with hundreds or thousands of cases of experience and background.

“So certainly, it levels and normalizes the playing field. And early on,
it normalizes the experience that practitioners can provide to their patients in personalizing the care recommendations. And then even
for very seasoned and experienced practitioners [who] have had their own subset of patients over career-long practice, AI will also bring in infinitely more data points of experience than even one practitioner — even seasoned ones — will have seen.” 

For more news on cancer updates, research and education, don’t forget to 

subscribe to CURE®’s newsletters here.

Artificial intelligence (AI) is increasingly integral to prostate cancer management, enhancing diagnosis and treatment stratification. AI's ability to predict seminal vesicle invasion and improve MRI accuracy was highlighted at the American Urological Association meeting. AI aids pathologists in identifying suspicious areas and assists in treatment decisions by categorizing patients' risk levels. Despite its potential, challenges such as data privacy, interpretability, and reliance on AI over human judgment persist. AI tools like Unfold AI are advancing precision medicine, offering personalized treatment plans and improving surgical outcomes.

CURE staff

Empowering the Immune System

Funding for Cancer Research: Hope in a State of Fear

A New Frontier in Melanoma Treatment

Utilizing AI in Prostate Cancer Care and Management

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