Case series of intralesional T-VEC in combination with topical imiquimod for in-transit metastatic melanoma

In-transit metastases of malignant melanoma pose a significant clinical challenge, particularly in patients with contraindications to systemic therapies. A case series of five patients of Northwestern Memorial Hospital (Chicago, IL) evaluated the combination of intralesional talimogene laherparepvec (T-VEC) and topical imiquimod for in-transit metastatic melanoma. The combination was tolerated well, without adverse events leading to discontinuation. One patient developed systemic progression during therapu, leading to early cessation of treatment. The other four patients had complete response by the end of the treatment course; all of these patients elected to continue topical imiquimod as maintenance following T-VEC. One of four patients developed metastatic nodal disease 10 months after the last T-VEC injection. The three other patients are free of cutaneous and systemic disease 2-57 months after their last injection. The authors conclude that these findings suggest that the combination of intralesional T-VEC and topical imiquimod can be an effective and safe treatment of in-transit metastases of melanoma.