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An Update on the Role of Talimogene Laherparepvec (T-VEC) in the Treatment of Melanoma: Best Practices and Future Directions

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Abstract

Talimogene laherparepvec (T-VEC) is the first agent approved for cancer in the emerging class of oncolytic viral therapies. While T-VEC was approved for the treatment of advanced melanoma in 2015, clinical utilization has been hampered by rapid changes in the therapeutic landscape of melanoma related to advances in both immune checkpoint blockade and targeted therapy, cumbersome logistics involved in T-VEC administration, biosafety concerns, and a perception that T-VEC has limited impact on uninjected, visceral disease. However, with further survival follow-up from the phase III OPTiM (OncovexGM-CSF Pivotal Trial in Melanoma), along with new real-world data and consensus guidelines on safe administration of oncolytic viruses, a roadmap for when and how to use T-VEC has been emerging. In addition, preliminary data have demonstrated improved therapeutic responses to T-VEC in combination with immune checkpoint blockade in patients with melanoma without additive toxicity. This review provides an update on recent data with T-VEC alone and in combination with other agents. The emerging data provide guidance for how to better utilize T-VEC for patients with melanoma and identifies critical areas for clinical investigation to expand the role of T-VEC in combination strategies for the treatment of melanoma and perhaps other cancers.

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Authors

Contributions

CAL conducted research and contributed to writing the manuscript and analysis of the data and provided final approval of the manuscript. NRL contributed to the analysis of the data and editing of the manuscript and provided final approval of the manuscript. AWS contributed to the initial conceptualization of the work, edited the manuscript, helped analyze the data, and provided final approval of the manuscript. HLK provided the initial concept for the manuscript, helped analyze the data and edit the manuscript and provided final approval of the manuscript.

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Correspondence to Howard L. Kaufman.

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No external funding was used in the preparation of this manuscript.

Conflict of interest

Howard L. Kaufman is an employee of Immuneering Corporation, serves as a consultant for Replimune, Inc., and is on a clinical advisory board for SapVax. Dr. Cecilia A. Larocca, Dr. Nicole R. LeBoeuf, and Dr. Ann W. Silk have no conflicts of interest that might be relevant to the contents of this manuscript.

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Larocca, C.A., LeBoeuf, N.R., Silk, A.W. et al. An Update on the Role of Talimogene Laherparepvec (T-VEC) in the Treatment of Melanoma: Best Practices and Future Directions. Am J Clin Dermatol 21, 821–832 (2020). https://doi.org/10.1007/s40257-020-00554-8

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