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Since the approval of talimogene laherparepvec (T-VEC, Imlygic®) by the Food and Drug Administration in 2015, Moffitt Cancer Center’s Cutaneous Oncology Program has been using this modified form of the herpes virus as a standard treatment for melanoma patients.

T-VEC is administered by injection directly into a tumor, sometimes under ultrasound guidance, while the patient is awake. It is a modified form of the herpes simplex 1 virus that works by killing cancer in two ways: by directly causing cancer cells to burst and by activating the immune system to attack tumors. Two of the genes in the virus have been removed so it can’t replicate in healthy cells.

A recent multi-institutional study led by Moffitt’s Cutaneous Oncology Program showed that out of the 121 melanoma patients who received T-VEC, 80 had a response to treatment within three months. At an average of nine months after receiving the treatment, 39% had complete response.

Dr. Jonathan Zager

“The logical next step is to combine T-VEC with other systemic therapies for melanoma patients and to do clinical trials to test it in other cancers,” said surgical oncologist Dr. Jonathan Zager, who was the principal investigator in the Phase 3 trial that led to approval by the United States Food and Drug Administration. “I think it’s promising with other cancers.”

Moffitt’s Sarcoma Program is hoping the treatment could work for patients with cutaneous angiosarcoma, a rare soft tissue sarcoma. “The clinical findings are often similar to melanoma, making this disease amenable to local injection,” surgical oncologist Dr. John Mullinax said. “The ultimate goal would be to initiate an immune response, resulting in tumor destruction.”

A patient receives a T-VEC injection as part of ongoing treatment for melanoma.

Mullinax is leading an investigator-initiated clinical trial at Moffitt to use T-VEC on adult patients with cutaneous angiosarcoma who have exhausted other treatment options, such as chemotherapy and radiation. Trial participants will be treated for up to a year               with injections every other week.