|Vector||Herpes simplex virus 1|
|Pronunciation||/ / tə-LIM-ə-jeen lə-HUR-pə-REP-vek|
|Trade names||T-Vec, Imlygic, OncoVexGM-CSF, others|
|Drug class||Oncolytic virus|
|Side effects||Tiredness, fever, nausea, pain at the site of injection, herpes infection|
|Typical dose||Up to 4 ml|
Talimogene laherparepvec (T-Vec), sold under the brand name Imlygic, is a medication used to treat melanoma that cannot be operated on. Specifically it is used for melanoma within and just under the skin. It is given by directly injecting into lesions. It has not been shown to affected life expectancy.
Common side effects include tiredness, fever, nausea, and pain at the site of injection. Other side effects include may include herpes infections, cellulitis or skin death at the site of injection, vasculitis, and plamacytoma. Use during pregnancy may harm the baby. It should not be used in people with a severely impaired immune system. It is a genetically engineered herpes virus (an oncolytic virus) which infects and multiplies inside melanoma cells, resulting in their death. It also stimulates an immune response against the cancer.
Talimogene laherparepvec was approved in the United States and Europe in 2015. In the United States it may cost up to 23,000 per dose as of 2021. In the United Kingdom this amount costs the NHS about £6,700.
In the US, talimogene laherparepvec is approved to treat Stage IIIb-IVM1c melanoma for whom surgical intervention is not appropriate and with tumors which can be directly injected; the EMA approved population in Europe is for Stage IIIb-IVM1a.
Talimogene laherparepvec extends survival in people with Stage IIIb-IVM1a melanoma and those who have not received prior systemic therapy for melanoma.
Talimogene laherparepvec is delivered by injecting it directly into tumors, thereby creating a systemic anti-tumor immune response.
The amount used depends on the size of the lesion up to a maximum of 4 ml.
Around half of people experience fatigue and chills; around 40% had fever, around 35% had nausea, and around 30% had flu-like symptoms as well as pain at the injection site. The reactions were mild to moderate in severity; 2% of people had severe reactions and these were generally cellulitis.
More than 10% of people had edema, headache, cough, vomiting, diarrhea, constipation, muscle pain, or joint pain. Between 1% and 10% developed cold sores, pain or infection in the lesion, anemia, immune mediated events (like vasculitis, pneumonia, worsening psoriasis, glomerulonephritis and vitiligo ), dehydration, confusion, anxiety, depression, dizziness, insomnia, ear pain, fast heart beating, deep vein thrombosis, high blood pressure, flushing, shortness of breath when exercising, sore throat, symptoms of the common cold, stomach pain, back pain, groin pain, weight loss, or oozing from the injection site.
The virus invades both cancerous and healthy cells, but it cannot productively replicate in healthy tissue because it lacks Infected cell protein 34.5 (ICP34.5). When cells are infected with a virus they shut down and die, but ICP34.5 blocks this stress response, allowing the virus to hijack the cell's translation machinery to replicate itself. A herpesvirus lacking the gene coding for ICP34.5 cannot replicate in normal tissue. However, in many cancer cells the stress response is already disrupted, so a virus lacking ICP34.5 can still replicate in tumors. After the virus has replicated many times, the cell swells and finally bursts, killing the cell and releasing the copies of the virus, which can then infect nearby cells.
While talimogene laherparepvec is using the cell's translation machinery to replicate, it also uses it to make the cell create GM-CSF. GM-CSF is secreted or released when the cancer cell bursts, attracting dendritic cells to the site, which pick up the tumor antigens, process them, and then present them on their surface to cytotoxic (killer) T cells which in turn sets off an immune response.
Talimogene laherparepvec is a biopharmaceutical drug; it is an oncolytic herpes virus that was created by genetically engineering a strain of herpes simplex virus 1 (HSV-1) taken from a person infected with the virus, rather than a laboratory strain. Both copies of the viral gene coding for ICP34.5 were deleted and replaced with the gene coding for human GM-CSF, and the gene coding for ICP47 was removed. In wild herpes virus, ICP47 suppresses the immune response to the virus; it was removed because the drug was designed with the intention of activating the immune system.
The first oncolytic virus to be approved by a regulatory agency was a genetically modified adenovirus named H101 by Shanghai Sunway Biotech. It gained regulatory approval in 2005 from China's State Food and Drug Administration (SFDA) for the treatment of head and neck cancer. Talimogene laherparepvec is the world's first approved oncolytic immunotherapy, i.e. it was also designed to provide systemic anti-tumor effects through the induction of an anti-tumor immune response.
Talimogene laherparepvec was created and initially developed by BioVex, Inc. under the brand OncoVEXGM-CSF. Development was continued by Amgen, which acquired BioVex in 2011. BioVex was founded in 1999, based on research by Robert Coffin at University College London, and moved its headquarters to Woburn, Massachusetts in 2005, leaving about half its employees in the UK.
Talimogene laherparepvec was approved by the U.S. Food and Drug Administration to treat melanoma in October 2015. It was the first approval of an oncolytic virus and the first approval of a gene therapy in the West. It was approved by the European Medicines Agency in December of that year.
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Amgen estimated that talimogene laherparepvec would be priced at US$65,000 per patient at the time it was approved.
As of 2016, talimogene laherparepvec had been studied in early stage clinical trials in pancreatic cancer, soft-tissue sarcoma, and head and neck squamous-cell carcinoma; it had also been tested in combination with checkpoint inhibitors ipilimumab and pembrolizumab.
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