Name of the Procedure:

Injection of Talimogene Laherparepvec (T-VEC), per 1 million plaque-forming units.

Summary

Talimogene laherparepvec, commonly referred to as T-VEC, is an immunotherapy injection used in the treatment of certain types of cancer, specifically melanoma. The injection is administered directly into the tumor, helping to destroy cancer cells and stimulate an immune response.

Purpose

Medical Conditions Addressed:

• Advanced melanoma (skin cancer).

Goals/Outcomes:

• Reduce the size of tumors.
• Slow the progression of cancer.
• Potentially lead to the destruction of cancer cells by the body's immune system.

Indications

Symptoms/Conditions:

• Locally advanced melanoma that cannot be surgically removed.
• Recurrent melanoma after previous treatments.

Patient Criteria:

• Diagnosed with melanoma.
• Unsuccessful previous treatments.
• Tumors accessible for direct injection.

Preparation

Pre-procedure Instructions:

• No specific fasting required.
• Inform the healthcare provider of current medications.
• Avoid anti-inflammatory medications or blood thinners as advised.

Diagnostic Tests/Assessments:

• Blood tests to assess overall health and readiness.
• Imaging studies to locate tumors.

Procedure Description

Step-by-Step Explanation:

1. Preparation: The area around the tumor is cleaned and sterilized.
2. Injection: Using a fine needle, T-VEC is injected directly into the tumor.
3. Monitoring: The injection site is monitored for any immediate adverse reactions.

Tools/Equipment:

• Sterile needles and syringes.
• Antimicrobial wipes and sterilization tools.

Anesthesia/Sedation:

• Local anesthesia may be applied to numb the injection site.

Duration

• The procedure typically takes 15 to 30 minutes.

Setting

• The injection is performed in an outpatient clinic or hospital setting.

Personnel

• Oncologist or specially trained healthcare provider.
• Nurse for assistance and patient monitoring.

Risks and Complications

Common Risks:

• Pain at the injection site.
• Flu-like symptoms (fever, fatigue).

Rare Risks:

• Severe infection.
• Autoimmune reactions.

Complications:

• Manageable with appropriate medical care and follow-up.

Benefits

• Shrinking of tumors in localized melanoma.
• Potential enhancement of the immune response against cancer.
• Benefits may begin to manifest within weeks to months of treatment.

Recovery

Post-procedure Care:

• Keep the injection site clean and dry.
• Follow-up appointments for monitoring response and administering additional injections if necessary.

Expected Recovery Time:

• Normal activities can usually be resumed shortly after the procedure.
• Some patients may require rest if experiencing flu-like symptoms.

Alternatives

Other Treatment Options:

• Surgery (if feasible).
• Chemotherapy and radiation therapy.
• Other forms of immunotherapy.

Pros and Cons of Alternatives:

• Surgery: Effective for localized tumors but not suitable for all patients.
• Chemotherapy/Radiation: Broadly targets cancer but comes with significant side effects.
• Alternative Immunotherapies: May work differently but with varying success rates and side effect profiles.

Patient Experience

During the Procedure:

• Mild discomfort from the injection.
• Possible brief stinging or pain at the injection site.

After the Procedure:

• Pain management with over-the-counter pain relief if necessary.
• Mild flu-like symptoms can be managed with rest and fluids.
• Regular follow-ups for additional injections and monitoring progress.