TY - CHAP M1 - Book, Section TI - Oncolytic Viral Therapy: Talimogene Laherparepvec A1 - Marples, Maria A2 - Board, Ruth E. A2 - Nathan, Paul A2 - Newsom-Davis, Tom A2 - Papa, Sophie A2 - Johnson, Peter Y1 - 2019 N1 - T2 - Problem Solving in Cancer Immunotherapy AB - A 68-year-old woman had her left great toe amputated for a 3.8 mm Breslow thickness ulcerated acral lentiginous subungual melanoma with microsatellites. Sentinel node biopsy showed multiple parenchymal deposits of melanoma; subsequent inguinal node dissection showed melanoma deposits in three of eight nodes. A staging CT scan was clear. BRAF mutation status was wild-type.Two years after initial surgery she developed in-transit metastases in the left leg, treated with excision and cryoablation. She then presented in the plastic surgery clinic with painful fungating nodules measuring up to 1 cm on the left leg, groin and buttock. Her performance status was 1.Her medical history included hypertension (with a non-ST segment elevation myocardial infarction 3 months previously), rheumatoid arthritis and non-insulin-dependent diabetes mellitus. She was taking aspirin, ramipril, bendroflumethiazide, naproxen and metformin. A reassessment CT scan of the head, neck, chest, abdomen and pelvis showed no visceral metastases. Her lactate dehydrogenase (LDH) level was 3.01 μkat/l (normal range 1.7–3.4 μkat/l).She was treated with talimogene laherparepvec (T-VEC). After two treatments she had fever of 38°C, managed with paracetamol. She had paracetamol premedication with subsequent cycles and had no further fevers. During the first 3 months she developed new lesions but remained well, so treatment continued. At 6 months her disease was noted to be stable.How did BRAF testing influence the treatment options for this patient?What is T-VEC, and what is the evidence base for treating melanoma patients with it?How is T-VEC administered?How should treatment be modified in patients who develop new lesions while receiving T-VEC?What extra precautions should patients take while they are being treated with T-VEC? SN - PB - EBN Health CY - New York, NY Y2 - 2021/03/09 UR - hemonc.mhmedical.com/content.aspx?aid=1160633580 ER -