Emory Surgical Oncologists and Surgery Residents Participate in Study Confirming the Ability of Virus to Combat Melanoma

February 2019

Emory Department of Surgery surgical oncologists Keith Delman, MD, and Michael Lowe, MD, collaborated in a multi-institutional study which found that a genetically-modified herpes virus is a viable treatment for patients with unresectable melanoma. Emory general surgery residents Raheel Jajja, MD, and Matthew Perez, MD, assisted Dr. Delman and Dr. Lowe in acquiring and interpreting data. Faculty from the University of North Carolina at Chapel Hill and Moffitt Cancer Center also participated in the study, and the results were published January 25 in the Journal of the American College of Surgeons.

The study aimed to better characterize the efficacy of talimogene laherparepvec (TVEC), an oncolytic herpes virus, in treating patients with unresectable stage IIIB to IV melanoma. TVEC, a genetically modified form of what is commonly defined as the cold sore virus, is designed so that it replicates inside the melanoma cells and kills them, while avoiding normal, healthy cells. TVEC has been FDA-approved for this purpose, and Emory also played an integral role in the multicenter phase III clinical trial that led to this approval.

The research team performed an IRB-approved review of all patients who received TVEC at Emory, UNC, and Moffitt from October 2015 to October 2018. Clinicopathologic characteristics, TVEC treatment data, and outcomes were assessed.

Of the 121 patients that received TVEC in this period, 80 patients had available treatment response data with at least three-month follow-up. Anatomic sites treated were 19 head and neck (24%), nine upper extremity (11%), twelve torso (15%), and 40 lower extremity (50%). Thirty-four patients (42.5%) did not receive therapy before TVEC.

Side effects were mild and self-limited, most commonly flu-like symptoms seen in 22 patients (28%). Median follow-up was nine months (range three to 28 months), with complete local response in 31 patients (39%) and partial response in 14 (18%). Of complete responders, 29 (37%) had no evidence of disease at last follow-up and received a median of six (range two to 12) cycles of therapy.

The investigators concluded that TVEC is a well-tolerated, durable treatment option for patients with unresectable locoregional melanoma, particularly in stage IIIB/C disease. Additionally, they found that TVEC can be administered safely across anatomic sites that are otherwise not amenable to other local therapies.