Ultrasound-guided Intralesional Injection of Talimogene laherparepvec (Imlygic) for Advanced Melanoma: Technical Note on a Preliminary Experience.

Purpose: To evaluate the safety and feasibility of ultrasound-guided intralesional injection of Talimogene laherparepvec (Imlygic, T-VEC) in patients with advanced non-palpable melanoma.

Materials And Methods: Fourteen consecutive patients (mean age, 67.9 years ± 13.0; range, 40-88; 12 males) with unresectable, locally advanced melanoma underwent ultrasound-guided intralesional injections of T-VEC (July 2016-March 2020) into subcutaneous lesions. Tumor response to the injection was evaluated at the last follow-up. Technical success and complication rates were recorded.

Results: The T-VEC injection was technically successful in all patients with all lesions successfully punctured (100%). The mean number of lesions, injection cycles, and injection volumes were 4.1 ± 2.6 (1-9), 6.5 ± 3.0 (3-12), and 2.6 mL ± 1.4 (1-4 mL), respectively. During the follow-up period (mean, 21.0 months ± 13.4; range 1-43.6 months), complete remission, partial remission, persistent disease, and disease progression were observed in 6 (42.9%), 3 (21.4%), 1 (7.1%), and 4 (28.6%) patients, respectively. Post-treatment symptoms observed in 9 patients (64.3%), including fever (n = 2), fatigue (n = 1), headache (n = 1), pain (n = 1), mouth sores (n = 1), and flu-like symptoms (n = 3). No injection-related complications occurred in all procedures.

Conclusion: Intralesional injection of T-VEC for non-palpable metastases under ultrasound guidance is safe and feasible in patients with advanced melanoma.