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Onco Targets Ther. 2017 Aug 2;10:3867-3880. doi: 10.2147/OTT.S133699. eCollection 2017.

A practical guide to the handling and administration of talimogene laherparepvec in Europe.

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NIHR Biomedical Research Centre, The Institute of Cancer Research/The Royal Marsden Hospital, London, UK.
Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Hospital Clinic de Barcelona, IDIBAPS, CIBER de enfermedades raras, Barcelona, Spain.
FIS del Instituto de Salud Carlos III, Madrid, Spain.
Department of Research and Development, Amgen Switzerland AG, Zug, Switzerland.
Head and Neck Unit, The Royal Marsden Hospital, London, UK.
Skin Cancer Centre/Dermatology Clinic, Universitätsspital Zürich, Zurich, Switzerland.


Talimogene laherparepvec is a herpes simplex virus-1-based intralesional oncolytic immunotherapy and is the first oncolytic virus to be approved in Europe. It is indicated for the treatment of adults with unresectable melanoma that is regionally or distantly metastatic (stage IIIB, IIIC, and IVM1a) with no bone, brain, lung, or other visceral disease. Talimogene laherparepvec is a genetically modified viral therapy, and its handling needs special attention due to its deep freeze, cold-chain requirements, its potential for viral shedding, and its administration by direct intralesional injection. This review provides a practical overview of handling, storage, and administration procedures for this agent in Europe. Talimogene laherparepvec vials should be transported/stored frozen at a temperature of -90°C to -70°C, and once thawed, vials must not be refrozen. Universal precautions for preparation, administration, and handling should be followed to avoid accidental exposure. Health care providers should wear personal protective equipment, and materials that come into contact with talimogene laherparepvec should be disposed of in accordance with local institutional procedures. Individuals who are immunocompromised or pregnant should not prepare or administer this agent. Talimogene laherparepvec is administered by intralesional injection into cutaneous, subcutaneous, and/or nodal lesions that are visible, palpable, or detectable by ultrasound. Treatment should be continued for ≥6 months. As with other immunotherapies, patients may experience an increase in the size of existing lesion(s) or the appearance of new lesions (ie, progression) prior to achieving a response ("pseudo-progression"). As several health care professionals (eg, physicians [dermatologists, surgeons, oncologists, radiologists], pharmacists, nurses) are involved in different stages of the process, there is a need for good interdisciplinary collaboration when using talimogene laherparepvec. Although there are specific requirements for this agent's storage, handling, administration, and disposal, these can be effectively managed in a real-world clinical setting through the implementation of training programs and straightforward standard operating procedures.


herpes simplex virus; intralesional injection; melanoma; oncolytic immunotherapy; practical considerations; talimogene laherparepvec

Conflict of interest statement

Disclosure KJH has acted as a consultant/in an advisory role for Amgen, Bristol-Myers Squibb (BMS), Genelux Corp., Lytix, Merck Serono, Merck Sharp & Dohme (MSD), Oncolytics Biotech, Oncos Therapeutics, Pfizer, and Viralytics. OM has acted as a consultant/advisor for Amgen Inc., BMS, MSD, Novartis, and Roche, and received travel/accommodation from BMS and MSD. JM has received honoraria from Amgen Inc., BMS, MSD, Novartis, and Roche, has acted as a consultant/advisor for Amgen Inc., BMS, MSD, Novartis, and Roche, and has received research funding for institution from BMS, GlaxoSmithKline, MSD, Novartis, and Roche. IPG is an Amgen Switzerland AG employee and owns restricted shares in Amgen. LG has acted in an advisory role for Amgen. RD has intermittent, project-focused consulting and/or advisory relationships with Amgen, BMS, MSD, Novartis, Pierre Fabre, Roche, and Takeda, outside the submitted work. ALF has no conflicts of interest to declare.

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