- Advanced melanoma patients often face a risk of recurrence postsurgery.
- New approaches, like immunotherapies before surgery, could potentially help improve the body’s ability to fight cancer and improve patient outcomes.
- An innovative approach using a genetically modified herpes virus, known as Talimogene laherparepvec (T-VEC), is gaining traction as it directs immune cells to attack cancer cells, potentially revolutionizing melanoma treatment.
In a phase 2 clinical trial, researchers examined an innovative approach using a genetically modified herpes virus to treat advanced melanoma. The findings were published in JAMA Oncology
The study involved 150 patients with advanced melanoma from various places worldwide.
The Talimogene laherparepvec (T-VEC) is designed to infect and replicate within tumor cells and attract immune cells like T cells and natural killer cells to attack cancer.
The patients they included had a specific type of melanoma that could be surgically removed and had one or more tumors that could be injected with the treatment.
The researchers divided the patients into two groups: one group received injections of neoadjuvant T-VEC followed by surgery (group 1), and the other group had surgery alone without the treatment (group 2).
Immunotherapy injected directly into skin cancer tumors
The treatment the researchers used, T-VEC, was injected directly into the tumors.
They started with a lower dose and gradually increased it over the course of several weeks until the patients had surgery or their tumors were no longer injectable, or they couldn’t tolerate the treatment.
The researchers followed the patients for about 5 years. After this time, they found that the group with the T-VEC treatment followed by surgery had a better chance of not having their cancer return (22.3% vs. 15.2% for the surgery-only group).
This suggests that the T-VEC treatment helped reduce the risk of cancer recurrence.
Improved patient outcomes in immunotherapy group
These findings suggest that T-VEC treatment before surgery can make a real difference in how well patients do regarding cancer recurrence, overall survival, and avoiding distant cancer spread. Importantly, the treatment appears to be safe.
The better outcomes are likely due to the treatment triggering the immune system to fight cancer more effectively, as seen from increased levels of certain immune cells after T-VEC treatment.
It’s important to note that the study had some limitations in its design, especially in how it defined and measured cancer recurrence.
However, these results provide a strong basis for exploring further studies combining neoadjuvant T-VEC with other treatments like checkpoint inhibitors, aiming to treat high risk melanoma that can be surgically removed.
T-VEC’s potential in improving melanoma treatment
Dr. Trevan Fischer, surgical oncologist and assistant professor of surgical oncology for Saint John’s Cancer Institute at Providence Saint John’s Health Center in Santa Monica, CA, not involved in this research, told Medical News Today that “intralesional therapy has been around for decades. This genetically modified virus has several advantages that make it an attractive research therapeutic option. This data reports the final report at 5 years showing an added benefit to using T-VEC before surgery.”
However, “many things have changed in the field of melanoma since this trial began in 2015,” Dr. Fischer pointed out.
“New and effective systemic agents have been developed and approved. In 2023, it’s rare anyone would use T-VEC and surgery alone with these advances and identifying who may need intralesional therapy to turn a “cold tumor into a hot tumor” is research that is needed and ongoing.”
– Dr. Trevan Fischer
MNT also spoke with Dr. Wael Harb, hematologist and medical oncologist at Memorial Care Cancer Institute at Orange Coast Medical Center in Fountain Valley, CA,and Vice President of Medical Affairs at Syneos Health, not involved in the research.
Dr. Harb said the “research represents a significant stride in understanding the role and efficacy of neoadjuvant therapies for advanced melanoma.”
“The results underscore the potential of combining T-VEC, an oncolytic virus, with surgical interventions to achieve better Recurrence-Free Survival (RFS) and Overall Survival (OS) rates. Adhering to the CONSORT guidelines, the study is a testament to methodological rigor and provides crucial insights into a burgeoning area of melanoma treatment.”
– Dr. Wael Harb
Implications for treating melanoma, improving survival rates
Dr. Harb noted how “the demonstrated improvement in RFS and OS suggests that the combination of neoadjuvant T-VEC and surgery might offer a more potent therapeutic regimen for melanoma patients, especially those at the specified stages.”
In addition, “it adds another dimension to the therapeutic choices clinicians have at their disposal,” Dr. Harb explained.
“While the paper brings forth optimism, it also highlights some limitations, like its smaller sample size and lack of control arms for neoadjuvant Immune Checkpoint Inhibitors (ICIs) or T-VEC combinations. This calls for more comprehensive studies, potentially phase 3 randomized trials, to ascertain these findings’ generalizability.
The study also nudges towards exploring the synergistic effects of combining T-VEC with adjuvant immunotherapy or BRAF inhibitors, a direction that could be immensely fruitful given the evolving landscape of melanoma therapeutics.”
– Dr. Wael Harb
Another important implication of this research is how it can help to raise hope and awareness.
“Such research shines a beacon of progress, enlightening the general public about melanoma treatment advancements,” Dr. Harb pointed out.
“For patients and their loved ones, it represents a beacon of hope, signifying strides towards improved survival rates and enhanced life quality.”
Dr. Harb concluded, “This paper accentuates the importance of integrating innovative therapeutic agents with traditional surgical procedures.”
“While we celebrate these findings, they also serve as a clarion call for further in-depth research, ensuring that we continue to refine our treatment approaches for the betterment of melanoma patients.”
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