Into the clinic: Talimogene laherparepvec (T-VEC), a first-in-class intratumoral oncolytic viral therapy

Abstract

With the recent regulatory approval of Talimogene laherparepvec (T-VEC) for the treatment of advanced of melanoma in the United States, Europe and Australia, oncolytic virus immunotherapy has earned its place in the clinic. However, the adoption of T-VEC by the U.S. oncology community has been slow, and so far has been largely limited to specialized cancer centers. Limiting factors include the intratumoral route of administration, which is unfamiliar to medical oncologists, biosafety concerns related to the use of a live virus in the clinic, and the explosion of other therapeutic strategies now available for the treatment of advanced melanoma. Herein, we review the development of T-VEC, and suggest how it fits into the in the current clinical treatment paradigm, and provide pearls for drug preparation, administration, and monitoring of response to therapy.

Fig. 1

T-VEC administration. a Fan technique. Enter at a single insertion point as far as the needle allows within the lesion to achieve even and complete dispersion. Inject within the lesion by pulling the needle back without exiting the lesion. Redirect the needle as many times as necessary in the shape of a fan while injecting the remainder of the dose of TVEC. Continue until full administration of vial. b Four quadrant technique. Mark the lesion in four different quadrants 2–3 mm apart. Enter one of the marked areas with the needle and inject virus. Exit the quadrant and move on to different area and repeat in all four quadrants until complete administration of dose. c Clustered dermal metastases. When lesions are clustered together, they can be measured and injected as a single lesion. d Ultrasound. Ultrasound assistance can be used for lesions that are difficult to identify