Monday, 2 June 2014

Primary overall survival under T-Vec

This is a study comparing the injection of GM-CSF subcutaneous versus T-Vec intra-lesional in
277 patients with 2116 lesions. There was an interesting by-stander effect on un-injected skin lesions was roughly half the size of the response in injected lesion, but visceral lesions respond less well.
The median overall survival was 23.3 months on T-Vec versus 18.9 months on GM-CSF, and especially benefitting appear patients with Stage 3B/C, 4M1a disease who had had no prior adjuvant therapy. Side effects are rather local, so the therapy is rather well-tolerated.

The abstract can be found here:

So this could look like a therapy option for patients with Stage 3B/C and 4M1a Melanoma who have mainly skin metastases rather than visceral lesions.

As this is a treatment for Stage 3 patients who might or might not progress, side effects are an important topic as taken up by the last speaker of the session- so I think there will need to be a very careful stratification into groups of patients who will  benefit from receiving e.g. Ipi and where the associated side effects are 'worth' the benefit (overall survival benefit is not available yet in the EORTC study) and others who might be better off with e.g. T-Vec with less side effects….in conclusion, it seems that doing something instead of simply waiting might be a smart patient strategy.

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