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Talimogene Laherparepvec (T-VEC) for the Treatment of Advanced Locoregional Melanoma After Failure of Immunotherapy: An International Multi-Institutional Experience



Talimogene laherparepvec (T-VEC) is an oncolytic virus approved for the treatment of unresectable, recurrent melanoma. The role of T-VEC after progression on systemic immunotherapy (IO) remains undefined. The goal of this study was to characterize the efficacy of T-VEC after failure of IO in patients with unresectable metastatic melanoma.


An international, multi-institutional review of AJCC version 8 stage IIIB-IV melanoma patients treated with T-VEC after failure of IO was performed at six centers from October 2015-December 2020. Primary outcome was in-field response; secondary outcomes included analyses of in-field and overall progression-free survival (PFS) and in-field and overall disease-free survival (DFS) after a complete response. Subset analysis of T-VEC initiation sequentially after or concurrently with IO was performed.


Of 112 patients, median age at T-VEC initiation was 69 years (range 21–93); 65 (58%) were male. Before T-VEC, 57% patients received one IO regimen, 42% received two or more, with most patients (n = 74, 66%) receiving T-VEC sequential to IO. Most were stage 3C (n = 51, 46%) at T-VEC initiation, 29 (26%) received injections to nodal disease. Over median follow-up of 14 months, in-field response at final T-VEC injection was 37% complete (CR), 14% partial (PR). T-VEC initiation sequentially or concurrently did not significantly affect in-field response (p = 0.26). Median in-field PFS was 15 months (95% confidence interval 4.6-NE). Median overall DFS after CR was 32 months (95% confidence interval 17-NE).


T-VEC after failure of IO is effective in unresectable, metastatic stage IIIB-IV melanoma. T-VEC initiation sequentially or concurrently did not significantly affect in-field response.

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Supported by the Biostatistics and Bioinformatics Shared Resources at Moffitt Cancer Center, Tampa, FL (P30-CA076292).


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Correspondence to Jonathan S. Zager MD, FACS.

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J.S. has received research funding from Amgen. A.v.A. receives advisory board and consultancy honoraria from Amgen, Bristol-Myers Squibb, Novartis, MSD-Merck, Merck-Pfizer, Sanofi and 4SC, all paid to the institution. He has received research grants from Amgen, Bristol-Myers Squibb, and Novartis, all paid to the institution. F.C.’s institution receives research funding from Amgen, Merck and Novartis, a portion of which supports her salary. J.S.Z. has advisory board relationships with Merck speaker’s bureau for Pfizer and Sun Pharma. He also receives research funding from Amgen, Delcath Systems, Philogen, Provectus and Novartis. He also is a member of the speaker’s bureau for Amgen and SunPharma. A.S.—Consulting fees and sponsored travel from Iovance Biotherapeutics Inc. Consulting fees from Guidepoint and Defined Health Inc. Honorarium and sponsored travel from Physicians' Educational Resource, LLC. Patent royalties from methods to improve adoptive cell therapy using tumor-infiltrating lymphocytes. None of the financial disclosures are related to this present work. The remaining authors have no relevant conflicts of interest to disclose.

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Carr, M.J., Sun, J., DePalo, D. et al. Talimogene Laherparepvec (T-VEC) for the Treatment of Advanced Locoregional Melanoma After Failure of Immunotherapy: An International Multi-Institutional Experience. Ann Surg Oncol 29, 791–801 (2022).

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