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Microbes & Immunity

ORIGINAL RESEARCH ARTICLE
Factors associated with response to

talimogene laherparepvec in the treatment of
advanced melanoma

Anupama Balasubramanian * , Michela Salusti-Simpson , Peter Callas ,
2
1†
1 †
1,5
1,4
1,4
1,3
Conor O’Neill , Hibba Rehman , Shahid Ahmed , Mirabelle Sajisevi ,
1,3
Christopher J. Anker , and Jessica Cintolo-Gonzalez *
1,6
1 Larner College of Medicine, University of Vermont, Burlington, Vermont, United States of America
2 Department of Mathematics Statistics, College of Engineering and Mathematical Sciences, University of
Vermont, Burlington, Vermont, United States of America
3 Division of Surgical Oncology, Department of Surgery, University of Vermont Medical Center, Burlington,
Vermont, United States of America
4 Division of Hematology/Oncology, Department of Medicine, University of Vermont Medical Center,
Burlington, Vermont, United States of America
5 Division of Otolaryngology, Department of Surgery, University of Vermont Medical Center, Burlington,
Vermont, United States of America
6 Division of Radiation Oncology, University of Vermont Cancer Center, Burlington, Vermont, United
States of America
†These authors contributed equally
to this work. Abstract
*Corresponding authors: Talimogene laherparepvec (T-VEC) is currently the only United States Food and Drug
Anupama Balasubramanian
(anupama.balasubramanian@med. Administration-approved intralesional therapy for advanced melanoma. Recent studies
uvm.edu) have assessed the integration of T-VEC with systemic immunotherapy, though the
Jessica Cintolo-Gonzalez response remains variable. Therefore, we sought to identify factors associated with
(jessica.cintolo-gonzalez@
uvmhealth.org) the response to T-VEC by conducting a retrospective, single-center analysis involving
melanoma patients treated with T-VEC. In the present study, we recorded demographic
Citation: Balasubramanian A,
Salusti-Simpson M, Callas P, et al. and clinicopathological data, details of T-VEC treatments, prior and concurrent treatments,
Factors associated with response and clinical outcomes. The primary endpoint was the in-field overall response rate (ORR:
to talimogene laherparepvec complete + partial). Secondary endpoints included complete in-field response, defined
in the treatment of advanced
melanoma. Microbes & Immunity. as complete resolution of disease or a negative biopsy; disease failure-free survival
2024;1(1):3445. (DFFS), defined from the initiation of treatment as the time to progression in patients
doi: 10.36922/mi.3445 who did not experience a disease-free interval and time to recurrence in those who did;
Received: April 18, 2024 and overall survival (OS). We used two-sample t-tests for continuous variables and Fisher’s
exact test for categorical variables. DFFS and OS were further analyzed using the Kaplan–
Accepted: May 24, 2024
Meier method and log-rank tests for selected variables. Among the 18 patients who met
Published Online: June 4, 2024 the inclusion criteria, an in-field response was observed in 14 (78%) patients. Low disease
Copyright: © 2024 Author(s). burden (<5 lesions or a total diameter <5 cm) was associated with a higher in-field ORR
This is an Open-Access article compared to high-burden disease (100% vs. 43%, P = 0.01). There was a trend toward
distributed under the terms of the
Creative Commons Attribution decreased in-field ORR for patients with >2 prior lines of systemic therapy (P = 0.18). With
License, permitting distribution, a median follow-up of 386 days, DFFS was associated with BRAF wild-type melanoma (P =
and reproduction in any medium, 0.04), an in-field ORR (P = 0.007), and a measurable bystander response (P = 0.01). Two or
provided the original work is
properly cited. more prior lines of immunotherapy were associated with poorer survival (P = 0.006) and
worse DFFS (P = 0.02). In conclusion, despite a low sample size, we identified covariates
Publisher’s Note: AccScience associated with in-field ORR, DFFS, and OS, warranting further study.
Publishing remains neutral with
regard to jurisdictional claims in
published maps and institutional Keywords: Melanoma; In-transit metastases; Intralesional therapy; Immunotherapy;
affiliations. Talimogene laherparepvec; Imlygic ; T-VEC
®

Volume 1 Issue 1 (2024) 95 doi: 10.36922/mi.3445