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Puzanov I, Milhem MM, Minor D, Hamid O, Li A, Chen L, Chastain M, Gorski KS, Anderson A, Chou J, Kaufman HL, Andtbacka RHI. Talimogene Laherparepvec in Combination With Ipilimumab in Previously Untreated, Unresectable Stage IIIB-IV Melanoma. J Clin Oncol 2016; 34:2619-26. [PMID: 27298410 PMCID: PMC7189507 DOI: 10.1200/jco.2016.67.1529] [Citation(s) in RCA: 401] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Combining immunotherapeutic agents with different mechanisms of action may enhance efficacy. We describe the safety and efficacy of talimogene laherparepvec (T-VEC; an oncolytic virus) in combination with ipilimumab (a cytotoxic T-lymphocyte-associated antigen 4 checkpoint inhibitor) in patients with advanced melanoma. METHODS In this open-label, multicenter, phase Ib trial of T-VEC in combination with ipilimumab, T-VEC was administered intratumorally in week 1 (10(6) plaque-forming units/mL), then in week 4 and every 2 weeks thereafter (10(8) plaque-forming units/mL). Ipilimumab (3 mg/kg) was administered intravenously every 3 weeks for four infusions, beginning in week 6. The primary end point was incidence of dose-limiting toxicities. Secondary end points were objective response rate by immune-related response criteria and safety. RESULTS Median duration of treatment with T-VEC was 13.3 weeks (range, 2.0 to 95.4 weeks). Median follow-up time for survival analysis was 20.0 months (1.0 to 25.4 months). Nineteen patients were included in the safety analysis. No dose-limiting toxicities occurred, and no new safety signals were detected. Grade 3/4 treatment-related adverse events (AEs) were seen in 26.3% of patients; 15.8% had AEs attributed to T-VEC, and 21.1% had AEs attributed to ipilimumab. The objective response rate was 50%, and 44% of patients had a durable response lasting ≥ 6 months. Eighteen-month progression-free survival was 50%; 18-month overall survival was 67%. CONCLUSION T-VEC with ipilimumab had a tolerable safety profile, and the combination appeared to have greater efficacy than either T-VEC or ipilimumab monotherapy.
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Affiliation(s)
- Igor Puzanov
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT.
| | - Mohammed M Milhem
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT
| | - David Minor
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT
| | - Omid Hamid
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT
| | - Ai Li
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT
| | - Lisa Chen
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT
| | - Michael Chastain
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT
| | - Kevin S Gorski
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT
| | - Abraham Anderson
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT
| | - Jeffrey Chou
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT
| | - Howard L Kaufman
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT
| | - Robert H I Andtbacka
- Igor Puzanov, Vanderbilt University, Nashville, TN; Mohammed M. Milhem, University of Iowa, Iowa City, IA; David Minor, California Pacific Melanoma Center, San Francisco; Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles; and Ai Li, Lisa Chen, Michael Chastain, Kevin S. Gorski, Abraham Anderson, and Jeffrey Chou, Amgen, Thousand Oaks, CA; Howard L. Kaufman, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and Robert H.I. Andtbacka, University of Utah, Salt Lake City, UT
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