(LSM P7) The Physician Assistant's Role in Administering T-VEC for Advanced Melanoma: a Single Institution Experience

Kathleen Cunningham PA-C1, Ashley N. Culbreth PA-C1, James Sun MD1, Michael J. Carr MD, MS1, Bethany M. Withycombe PharmD, BCOP2, Jennifer R. Repp PharmD, BCOP2, Rene L. Mullen RN2, Christopher A. Puleo PA-C1, Jonathan S. Zager MD1 1Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 2Department of Pharmacy, Moffitt Cancer Center, Tampa, FL The Physician Assistant's Role in Administering T-VEC for Advanced Melanoma: a Single Institution Experience

Introduction: Talimogene laherparepvec (T-VEC) is a genetically modified oncolytic virus for the intralesional treatment of unresectable or recurrent metastatic melanoma presenting as cutaneous, subcutaneous or nodal lesions. We describe our Physician Assistant (PA)-centered T-VEC program.

Methods: We reviewed our T-VEC experience from 2015-2019. In clinic, patients are evaluated for appropriateness of T-VEC, photographs taken, consent obtained and dosage calculated with the clinical pharmacist based on lesion size. On injection day, patients apply topical anesthetic to injection sites 45 minutes before injection and T-VEC dosage is verified. Each lesion is injected using standard aseptic technique by the PA or physician. Injection sites are cleansed with alcohol and nonocclusive dressing is applied for 7 days to prevent virus transmission. The next procedure date is scheduled and T-VEC is ordered.

Results: 60 patients received 386 separate T-VEC treatments at our institution (median 5, IQR 4-8). Median age at first injection was 75 years (IQR 67-81). 34 patients (57%) had stage 3C disease and 31 (52%) patients had lower extremity involvement. Overall response rate was 53% (CR 33%, PR 20%) with median follow-up time of 10 months (IQR 6-20). Among responders, patients received a median of 3 (IQR 1.75-4.25) treatments prior to clinical response. The most frequent adverse events were flu-like symptoms within 48 hours of injection with decreased incidence after serial injections.

Conclusions: T-VEC remains a safe and effective therapy in this population. Integration of PAs into T-VEC workflow allows a large number of treatments to be performed without disruption of clinic flow.