Real-World Outcomes of Talimogene Laherparepvec Therapy: A Multi-Institutional Experience

Abstract

Talimogene laherparepvec (TVEC) is a FDA-approved oncolytic herpes virus used to treat unresectable stage IIIB-IV metastatic melanoma via intralesional injection. This study aims to characterize the efficacy TVEC in patients with unresectable stage IIIB-IV melanoma. We performed a multi-institutional, IRB-approved review of all patients who received TVEC at three centers from 10/2015–10/2018. Clinicopathological characteristics, TVEC treatment data and outcomes were assessed. One hundred twenty-one patients received TVEC, of which 80 patients had available treatment response data with at least three-month follow up. Anatomic sites treated: 19 (24%) head and neck, 9 (11%) upper extremity, 12 (15%) torso and 40 (50%) lower extremity. Thirty-four (42.5%) patients did not receive therapy prior to TVEC. Side effects were mild and self-limited, most commonly flu-like symptoms seen in 22 (28%) patients. Median follow-up was 9 (3-28) months, with complete local response (CR) in 31 (39%) and partial response (PR) in 14 (18%) patients. Of complete responders, 29 (37%) had no evidence of disease (NED) at last follow up and received a median of 6 (2-12) cycles of therapy. TVEC is a well-tolerated, durable treatment option for patients with unresectable locoregional melanoma particularly in stage IIIB/C disease. Additionally, we found that TVEC can be administered safely across anatomic sites that otherwise are not amenable to other local therapies.