Imlygic is an approved drug used to treat melanoma on the skin and lymph glands. This drug is different from usual chemotherapy drugs for cancer. Talimogene laherparepvec is actually a virus, specifically a type-1 herpes simplex virus (the same virus that causes cold sores) weakened and processed so it replicates inside cancer cells. The weakened virus infects cancer cells and also stimulates the body’s immune system to activate its own antitumor response.
Talimogene laherparepvec is a recently approved medication, and it is the first of its kind at the time of writing. Therefore, you need to take extra precautions and be monitored closely by the doctor throughout treatment.
Talimogene laherparepvec is injected to melanoma lesions, and therefore can only be given by health professionals.
2 What to Know Before Using
Before using Imlygic, you must know all about the risks and complications associated with it.
Here are things your doctor will consider before using Talimogene laherparepvec treatment:
Talimogene laherparepvec is indicated to treat localized melanoma lesions that recur after initial surgery, including lesions that cannot be removed using surgery. It is not known if the medication has benefit to melanoma with metastases. The doctor may do several tests to determine if Talimogene laherparepvec is suitable for you. Because Talimogene laherparepvec is a virus, there is a possibility of accidentally transmitting it to others, especially to those with weak or compromised immune systems.
The virus can cause herpes simplex infection. Those at risk include patients who are pregnant, undergoing treatment with steroids and immunosuppressive drugs, patients with autoimmune disorders (rheumatoid arthritis, lupus or psoriasis), blood and bone marrow cancers, having a history of cold sores, genital herpes, and HIV infection. Before using the drug, make sure to tell your doctor if anyone in the household has any of these conditions.
Talimogene laherparepvec carries a small risk of causing herpes simplex infection to you. However, note that leaving melanoma untreated can cause progression and prone to develop metastases until it becomes too difficult to treat. The doctor will carefully weigh the benefits of Talimogene laherparepvec before prescribing it to you.
Before using Talimogene laherparepvec, tell your doctor if you have conditions that can cause problems in the immune system, like HIV, leukemias, rheumatoid arthritis, lupus or psoriasis, or you use steroid medication. These conditions can reduce effectiveness and increase side effects of the drug.
Antiviral drugs can interact with Talimogene laherparepvec and diminish its therapeutic effect. Tell your doctor if you use antiviral drugs, as well as other medicines you are taking.
Do not breastfeed or get pregnant when using Talimogene laherparepvec. The drug can harm developing fetuses in pregnant women. If you get pregnant while and shortly before using Talimogene laherparepvec, call your doctor immediately. Breastfeeding is not recommended when using the drug.
To use Imlygic properly, you must follow all instructions given by your doctor.
Talimogene laherparepvec is prepared or administered by a doctor or nurse during visits to the health facility. The medication is injected directly into the tumor or lesions, or into a lymph node under the skin. The doctor determines the dose of Talimogene laherparepvec based on the total size of the lesions.
If you have melanoma lesions that are deep under the skin, the doctor may perform ultrasound imaging to locate and administer the drug to these lesions.
Talimogene laherparepvec injection requires careful steps to ensure that the medication is dispersed in the lesions. Expect that the doctor performs several injections, one per each lesion. The melanoma lesions are then covered by dressings, and the outside are carefully wiped with alcohol. Lesions must be covered by dressings for at least a week, and removed only when there is no weeping or oozing out of the injection site.
Talimogene laherparepvec is given every two weeks until the tumors are gone. The first two injections of the drug are given three weeks apart. If there is new appearance of lesions after a previous complete response, the Talimogene laherparepvec injections are given again.
4 Precautions to Take
Before using Imlygic, there are some precautions you must take.
Do not scratch or touch lesions where Talimogene laherparepvec is injected. If you accidentally touched a treated lesion, wash hands with soap and water or with rubbing alcohol.
Talimogene laherparepvec require careful handling and preparation. Because Talimogene laherparepvec is an essentially weakened type-1 herpes simplex virus, it is considered a hazardous agent. Individuals who are pregnant or have weak immune systems (including children) have to stay away from the drug. Health care providers who handled (prepared and administered) Talimogene laherparepvec must not take care of other patients with severe infections or wounds.
If you are having Talimogene laherparepvec treatment, you may have to keep a distance from pregnant individuals and children to avoid the possibility of transmitting the virus.
Make sure change soiled dressings daily. Ask your doctor or nurse for help on the proper way to change the dressings. The soiled dressings and other materials used in treatment are biohazardous, so place them all in a sealed leak-proof container and dispose of with household waste.
Always stick to scheduled treatments and clinic visits. Skipping or missing a dose may cause complications or allow cancer to progress.
Herpes simplex virus in the Talimogene laherparepvec can pass into body fluids; blood, semen, vaginal fluids, vomit, and semen. Avoid contact with body fluids, and instruct family members to do the same. Wear rubber gloves when cleaning up body fluids, handling contaminated clothing or trash, or changing diapers. All soiled clothing must be laundered separately. If you have sex, use a latex condom or other effective barrier birth control.
5 Potential Side Effects
As with many medications, there are several potential side effects associated with Imlygic.
Talimogene laherparepvec may cause the following side effects, which are serious and requires immediate medical attention:
Severe allergic reactions; hives, swelling of the face, mouth or throat, difficulty breathing
Having signs and symptoms of herpes simplex infection; tingling, burning pain around the mouth or genitals, weakness or cramps or burning pain in an arm or leg, confusion, severe drowsiness, formation of blisters on fingers, ears, around the mouth or genitals
Any skin lesion that does not heal
Oozing, swelling, warmth or redness at the injection site
Here are common side effects of Talimogene laherparepvec:
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