M3 - Talimogene Laherparepvec (TVEC) for the Treatment of Advanced Locoregional Melanoma after Failure of Immunotherapy: A Multi-Institutional Experience
Monday, February 17, 2020
7:45 AM – 8:00 AM
Location: Sebastian I 1/2
Background: TVEC is an oncolytic virus approved for the treatment of unresectable recurrent melanoma. Recent studies reported an overall response rate (ORR) of 57% with TVEC monotherapy and between 39-67% in combination with immunotherapy (IO). We evaluated the efficacy of TVEC after failure of IO in patients with unresectable metastatic melanoma.
Methods: We performed a multi-institutional review of AJCC 7 stage IIIB-IV patients treated with TVEC after failure of IO at 4 US centers from 2015-2019. Outcomes analyzed were in-field progression free- (IPFS), in-field disease-free survival (IDFS), overall DFS.
Results: Among 87 patients, median age was 69 years (IQR 59-77.5). Prior to TVEC, most patients received 1 IO regimen (67%) as opposed to 2 or more. Most patients received TVEC for in-transit disease (n=69, 79%) of the lower extremity (n=46, 53%). Median follow-up time was 7 months (IQR 3-12). In-field response after TVEC was 43% (23% CR, 20% PR). Median estimated IPFS was 31 months (95% CI 14.9-NE) and IDFS was 17 months (95% CI 13.5-NE). 19 patients (22%) had CR to TVEC injection of which 4 eventually recurred. Administration of TVEC added to IO (concurrent) or after failure of IO (sequential) did not significantly affect IPFS. Sequential and concurrent TVEC yielded ORR of 45% and 41%, respectively (p=ns).
Conclusions: TVEC with/without concurrent IO have an in-field ORR of 43% and an in-field CR of 23% after initial failure of IO. TVEC with IO as second- or later-line therapy is an efficacious treatment option for these patients.