Talimogene laherparepvec (T‐ VEC ) in advanced melanoma: complete response in a heart and kidney transplant patient. A case report

Abstract

SummaryTalimogene laherparepvec (T‐VEC) is a intralesional oncolytic virotherapy, licensed in the European Union for locoregional advanced melanoma of American Joint Committee on Cancer stages IIIB, IIIC and IVM1a. Organ transplant recipients are currently excluded from all clinical trials dealing with immunotherapies due to the risk of transplant rejection. A 58‐year‐old white man with a history of heart and kidney transplantation in 2014 was diagnosed with melanoma (Breslow thickness 1·6 mm, stage pT2a) on the left arm in September 2015. In March 2016 he developed in transit metastases, and local therapy with a combination of topical imiquimod (5%) and cryotherapy of individual lesions was initiated. However, in November 2016 therapy was stopped following local progression of the metastases. An interdisciplinary decision to treat the patient with T‐VEC was taken. After 11 cycles of T‐VEC, the patient showed a complete response. As of June 2018, 11 months after the last treatment cycle of T‐VEC, the patient continues to be tumour free. The patient tolerated the therapy well with only mild adverse events and did not show any sign of graft rejection or loss of function of the transplanted organs. We conclude that T‐VEC can be a potentially effective and safe treatment in patients with a history of organ transplantation. Nevertheless, due to this special situation, the risks and benefits should always be discussed with an interdisciplinary tumour board.

The Benefit of Reactivating p53 under MAPK Inhibition on the Efficacy of Radiotherapy in Melanoma

“…Furthermore, advanced cutaneous melanoma has developed into a prototype for testing checkpoint-modulating agents, which has increased hope for long-term tumor containment and a potential cure [2]. The next breakthrough in cancer treatment following the success in immunotherapy and using immune checkpoint inhibitors is the oncolytic virus therapy, which has been approved recently by the European Medicines Agency (EMA) and the United States (US) Food and Drug Administration (FDA) [3,4,5,6].…”

Complete remission from intralesional talimogene laherparepvec for regionally advanced Merkel cell carcinoma in an immunocompromised solid organ transplant patient

“… 4 , 5 , 6 , 7 T-VEC has also been used safely in a solid organ transplant patient with melanoma. 8 To our knowledge, this is the first case of successful treatment of MCC in a patient with a history of solid organ transplant using oncolytic virus therapy.…”

Insights into the Molecular Mechanisms Behind Intralesional Immunotherapies for Advanced Melanoma

“…Even in patients with adverse prognostic indicators (i.e., stage IVM1a/b disease, visceral metastases, multiple co-morbidities), T-VEC was able to produce a durable OR rate of 40% [59]. Furthermore, T-VEC was highly successful in the treatment of melanoma in prior transplant patients with an altered immune landscape [47], further supporting its ability to induce a potent anti-tumor immune response. Indeed, in patients who were treatment refractory to multiple immunotherapies, T-VEC was able to induce CRs and promote systemic immunity [48,107].…”