Injection, Talimogene Laherparepvec, 1 Million Plaque Forming Units (pfu) (C9472)

Name of the Procedure:

Common Name: T-VEC Injection
Technical/Medical Term: Injection, Talimogene Laherparepvec, 1 million plaque forming units (pfu) (C9472)

Summary

The T-VEC Injection is a procedure where a genetically modified virus is injected directly into skin cancer lesions. The virus works by infecting and killing cancer cells, which can help shrink tumors.

Purpose

Medical Conditions Addressed:

• Advanced melanoma, particularly when surgery is not an option

Goals/Expected Outcomes:

• To reduce the size of melanoma lesions
• To stimulate an immune response against cancer cells

Indications

Symptoms/Conditions That Warrant the Procedure:

• Unresectable metastatic melanoma (skin cancer that cannot be removed by surgery)

Patient Criteria:

• Patients who have melanoma lesions in the skin or lymph nodes
• Suitable for those who have not responded to other treatments

Preparation

Pre-Procedure Instructions:

• No fasting typically required
• Medication adjustments may be necessary as advised by the healthcare provider
• Diagnostic tests may include blood tests and imaging studies to assess the extent of cancer

Procedure Description

Step-by-Step Explanation:

1. The patient is made comfortable, typically in an outpatient setting.
2. The skin around the lesion is cleaned and disinfected.
3. Talimogene laherparepvec (T-VEC) is injected directly into the melanoma lesion using a syringe.

Tools and Technology:

• Syringe and needle for injection
• Talimogene laherparepvec (T-VEC) viral solution

Anesthesia/Sedation:

• Local anesthesia may be used to numb the area.

Duration

• The injection itself typically takes a few minutes. The entire visit may last about an hour to allow for preparation and observation.

Setting

• The procedure is commonly performed in an outpatient clinic or a hospital's oncology department.

Personnel

• A trained oncologist or a specialized nurse is usually responsible for administering the injection.

Risks and Complications

Common Risks:

• Injection site pain
• Fever
• Fatigue
• Nausea

Rare Risks:

• Severe immune reactions
• Infection at the injection site
• Spread of the virus to other non-target sites

Management of Risks:

• Close monitoring by healthcare professionals
• Symptomatic treatment for fever and pain
• Antibiotics for any potential infections

Benefits

Expected Benefits:

• Reduction in the size of melanoma lesions
• Potential activation of the body's immune system to fight other cancer cells

Realization Time:

• Benefits may be observed within a few weeks to months post-injection.

Recovery

Post-Procedure Care:

• Keep the injection site clean and dry
• Follow any additional instructions provided by healthcare professionals

Expected Recovery Time:

• Patients can typically return to normal activities shortly after the procedure. Some may experience mild side effects like fatigue.

Restrictions and Follow-Up:

• Regular follow-up appointments are necessary to monitor the response to treatment and manage any side effects.

Alternatives

Other Treatment Options:

• Surgical removal of melanoma lesions
• Systemic immunotherapy (e.g., checkpoint inhibitors)
• Targeted therapy
• Radiation therapy

Comparison Pros and Cons:

• T-VEC may offer local tumor control with potentially fewer systemic side effects compared to some systemic treatments.
• Other treatments might be necessary based on the extent and progression of the disease.

Patient Experience

During the Procedure:

• Mild discomfort at the injection site
• Local anesthesia may be used to minimize pain

After the Procedure:

• Mild to moderate pain or swelling at the injection site
• Possible flu-like symptoms managed with over-the-counter medications
• Most patients report returning to daily activities shortly after the injection