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Patient Handout: Intralesional Talimogene Laherparepvec (TVEC)

What is Intralesional TVEC?

Intralesional Talimogene Laherparepvec (TVEC), commonly referred to as T-VEC, is a type of immunotherapy used to treat certain types of melanoma (a form of skin cancer) that have spread or cannot be removed surgically. It is specifically designed to be injected directly into melanoma tumors, where it helps stimulate the body’s immune system to recognize and attack the cancer cells.

T-VEC is a genetically modified virus that has been altered to replicate inside melanoma cells. This replication leads to the destruction of the melanoma cells and enhances the immune response against the cancer.

How Does TVEC Work?

TVEC is a modified version of the herpes simplex virus (HSV), which is designed to selectively infect and replicate within melanoma tumors. When TVEC is injected directly into a tumor:

  1. Infection of tumor cells: The modified virus infects the cancer cells in the tumor.
  2. Tumor destruction: As the virus replicates inside the tumor cells, it causes them to break apart, killing the cancer cells.
  3. Immune system activation: The destruction of the melanoma cells releases proteins that alert the immune system to the presence of cancer. This can help the body’s immune cells, like T cells, recognize and destroy cancer cells elsewhere in the body.

How is TVEC Given?

  • Intralesional injection: TVEC is injected directly into the melanoma tumor(s) by your healthcare provider. This injection is typically given in a medical office or clinic.
  • Treatment schedule: TVEC is usually administered once every 2 weeks for the first 6 months of treatment. After that, your doctor may reduce the frequency of injections depending on your response to the therapy.
  • Monitoring: You will be monitored during and after each injection for any reactions or side effects. Your healthcare team will track the response of the tumor(s) to the therapy.

Possible Side Effects

While TVEC is an effective treatment, it can cause side effects. Some people may experience mild effects, while others may have more significant reactions. It’s important to be aware of the possible side effects:

  • Common side effects:
    • Injection site reactions (redness, swelling, pain, or itching)
    • Flu-like symptoms (fever, chills, fatigue)
    • Pain at the tumor site
    • Rash or skin irritation
    • Nausea
    • Headache
  • Serious side effects (contact your healthcare provider immediately if you experience any of these):
    • Infection: Since TVEC is derived from a virus, there is a risk of infection at the injection site or elsewhere in the body.
    • Fever or chills: Severe flu-like symptoms, including high fever, can occur after injection and may indicate an immune response.
    • Pain or swelling: Unusual pain or swelling, especially around the injection site, can sometimes occur.
    • Immune-related side effects: TVEC can cause an overactive immune response, which might result in symptoms like difficulty breathing, chest pain, or swelling in parts of the body.

Precautions

Before starting TVEC treatment, inform your doctor if you have:

  • Weak immune system: If you have a history of weakened immunity, such as from HIV/AIDS or immunosuppressive medications, let your doctor know, as TVEC could affect your immune system.
  • Pregnancy or breastfeeding: TVEC should not be used during pregnancy because it could harm the unborn baby. It is also not recommended during breastfeeding. Be sure to discuss birth control options and pregnancy plans with your healthcare provider before starting treatment.
  • Cold sores or herpes infections: Since TVEC is based on the herpes simplex virus, people with a history of herpes infections should inform their doctor, as there is a possibility of reactivation of the virus.

What to Expect During Treatment

  • Injection procedure: TVEC will be injected directly into the tumor. The injection itself is usually quick, but some patients may experience mild pain or discomfort at the injection site.
  • Side effect management: If you experience flu-like symptoms or discomfort at the injection site, your doctor may recommend medications to help relieve these side effects.
  • Monitoring: After each treatment, your doctor will monitor you for any adverse reactions. You may also undergo imaging tests to see how well the tumor is responding to the treatment.

What to Do in Case of an Emergency

Seek immediate medical help if you experience:

  • Severe allergic reaction (difficulty breathing, swelling of the face, lips, or throat)
  • Symptoms of infection, such as redness, swelling, warmth, or pus at the injection site
  • High fever or chills that do not go away
  • Difficulty breathing, chest pain, or swelling in the arms, legs, or face
  • Unusual pain, bleeding, or bruising that persists

Pregnancy and Breastfeeding

  • Pregnancy: TVEC can harm an unborn baby and should not be used during pregnancy. If you are pregnant, plan to become pregnant, or think you might be pregnant, inform your doctor before starting treatment.
  • Breastfeeding: TVEC is not recommended during breastfeeding, as it may pass into breast milk and harm your baby. You should stop breastfeeding while receiving this treatment.

Lifestyle Tips

  • Take care of your skin: Since TVEC is administered through the skin, it’s important to protect the treated area from sunburn. Use sunscreen and wear protective clothing when going outside.
  • Stay hydrated: Drink plenty of fluids to help manage side effects like flu-like symptoms or fatigue.
  • Rest: If you experience tiredness or flu-like symptoms, make sure to rest and allow your body time to recover between treatments.
  • Report changes to your doctor: Always report any new or unusual symptoms, including changes at the injection site or flu-like symptoms, to your healthcare provider.

Conclusion

Intralesional TVEC is an innovative treatment option for melanoma. It works by using your body’s immune system to fight cancer, and it can be effective in shrinking tumors and improving outcomes for patients with melanoma. Be sure to follow your doctor’s instructions and attend all scheduled appointments to monitor your progress.

If you have any questions or concerns about your treatment with TVEC, do not hesitate to speak with your healthcare provider. They can provide more personalized information and help manage any side effects that may arise.

Disclaimer: This handout is for educational purposes only and is not intended as medical advice. Always consult your healthcare provider for specific medical guidance regarding your treatment.