Reviewed by: HU Medical Review Board | Last reviewed: February, 2022.
Talimogene laherparepvec is a type of medication called an “oncolytic virus.” An oncolytic virus is a virus that makes copies of itself (replicates) in cancer cells. The virus spreads within the tumor, helping to minimize damage to normal cells.1 This medication is a type of immunotherapy.
Talimogene laherparepvec is used to treat melanoma in the skin and lymph nodes.2 It is only used on cancer that has recurred (come back) after initial surgery, if the lesions cannot be removed with additional surgery. Talimogene laherparepvec cannot be used to treat melanoma that has spread to your internal organs.
Talimogene laherparepvec is abbreviated T-VEC or called by the brand name Imlygic. T-VEC does not come in generic form.
How does T-VEC work?
T-VEC is a weakened version of the herpes simplex virus. Herpes simplex is the virus that causes cold sores. The virus has been genetically modified, so that it generally does not cause cold sore blisters.2,3 “Genetically modified” means that the virus’ DNA has been changed in a lab. The exact way that T-VEC works is unknown.2 It seems to affect the body in multiple ways that result in tumor destruction.
The modified herpes virus causes tumor cells to rupture (burst open) and die.2 This is how T-VEC kills cancer cells directly.4
The dying tumor cells release antigens.2 Antigens are molecules that trigger an immune response. Certain immune cells learn to recognize specific antigens and become active. In this way, T-VEC acts like a vaccine.4 It trains immune cells to recognize tumor antigens and fight cancer cells.
Finally, T-VEC–infected cells make a protein called GM-CSF.2 GM-CSF stands for granulocyte-macrophage colony-stimulating factor. GM-CSF creates a general immune response. It tells your body to make more white blood cells.5 White blood cells fight foreign and unhealthy cells, including abnormal cancer cells.
How is T-VEC given?
Your doctor will inject T-VEC directly into your melanoma tumors.2 Your doctor may not treat every tumor at each treatment session. Treatment will continue as long as you have tumors, unless the melanoma worsens or side effects are unacceptable.
Before receiving T-VEC, read the Medication Guide that comes in the package.
What are the side effects of T-VEC?
Most side effects are mild or moderate, and they generally improve within 3 days. The most common side effects of T-VEC include:
- Flu-like symptoms
- Pain at the injection sites
Contact your doctor if you have signs of a possible herpes infection, including2:
- Blister on the mouth or genitals that burns, tingles, or feels painful
- Eye problems (pain, light sensitivity, discharge from the eyes, blurry vision)
- Weakness in the arms or legs
- Feeling very sleepy or drowsy
- Mental confusion
This is not an exhaustive list of all potential side effects of T-VEC. Talk to your healthcare provider or pharmacist for further information.
Who should not take T-VEC?
T-VEC is a weakened but live version of the herpes virus. For this reason, you should not use T-VEC if you have a weakened immune system due to disease or medical treatment. Tell your doctor about medical conditions you have or had, especially2:
- HIV infection or AIDS
- Blood or bone marrow cancer
- Autoimmune disease
Tell your doctor about medications you are taking, particularly:
- Antiviral medications such as acyclovir to treat herpes.
- Steroids or other medications that weaken your immune system.
If you are pregnant, plan to become pregnant, or are breastfeeding or plan to breastfeed, talk with your doctor. T-VEC can cause harm to a developing fetus and should not be given to women who are pregnant. While receiving T-VEC, females who can become pregnant should use contraceptives during treatment (patients should discuss appropriate birth control methods, and how long they need to use them, with their doctor). Females should not breastfeed during T-VEC treatment (patients should discuss breastfeeding considerations with their doctor).
What precautions are needed during treatment with T-VEC?
Accidental exposure to T-VEC can lead to herpes infection. Proper care of the treatment sites is important to prevent the virus from spreading.2
Tell your doctor if you have close contact with someone who is pregnant or has a weak immune system. It is particularly important not to spread the virus to that person. A close contact is a household member, caregiver, sex partner, or someone sharing the same bed.2
To avoid spreading T-VEC:2
- Avoid direct contact between your treatment sites, dressings, or body fluids and another person.
- Keep treatment sites covered with air- and watertight dressings for at least 1 week after each treatment. If the site is still oozing or weeping after 1 week, keep it covered.
- Wear gloves while changing your dressings.
- Replace the dressing if it falls off.
- Place used dressing and cleaning materials in a sealed bag. Throw it away in the garbage.
- Do not touch or scratch the treatment sites.
Before starting treatment with T-VEC, patients should tell their doctor about all medications (prescription and over-the-counter), herbal supplements, and vitamins they are taking. Patients should talk to their doctor if they have any questions, or if they have questions regarding their T-VEC regimen.