Tumor-infiltrating lymphocyte therapy in metastatic vulvar melanoma: A case report and review of the literature

BACKGROUND: Vulvar melanoma is a rare and aggressive malignancy comprising less than 1% of all melanomas in women. Despite advances in immune checkpoint blockade, durable responses remain limited, and treatment of refractory disease poses a major challenge. Tumor-infiltrating lymphocyte (TIL) therapy has emerged as a promising option for patients with metastatic mucosal melanoma resistant to standard immunotherapy. CASE: We report a 48-year-old woman diagnosed with multifocal, unresectable vulvar melanoma who initially received ipilimumab and nivolumab, but discontinued due to immune-related colitis and progression of disease. She subsequently developed pulmonary, hepatic, and nodal metastases and underwent palliative vulvectomy for symptomatic relief. Following left inguinal lymph node harvest and autologous TIL expansion, she received lymphodepleting chemotherapy, TIL (lifileucel) infusion, and adjuvant interleukin-2 therapy. Her treatment course was notable for transient transaminitis, rash, and reversible encephalopathy. Follow-up PET-CT demonstrated a partial metabolic response with resolution of hepatic lesions and decreased pulmonary nodularity. CONCLUSION: This case highlights the potential clinical benefit of TIL therapy in metastatic vulvar melanoma following checkpoint inhibitor failure, supporting its consideration as an emerging therapeutic option in this rare gynecologic malignancy.