RT Book, Section
A1 Marples, Maria
A2 Board, Ruth E.
A2 Nathan, Paul
A2 Newsom-Davis, Tom
A2 Papa, Sophie
A2 Johnson, Peter
SR Print(0)
ID 1160633580
T1 Oncolytic Viral Therapy: Talimogene Laherparepvec
T2 Problem Solving in Cancer Immunotherapy
YR 2019
FD 2019
PB EBN Health
PP New York, NY
SN 9780995595422
LK hemonc.mhmedical.com/content.aspx?aid=1160633580
RD 2021/03/07
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?