Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA.
Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
J Immunother Cancer. 2022 Oct;10(10). doi: 10.1136/jitc-2022-005257.
Talimogene laherparepvec (T-VEC) has become an increasingly popular treatment option for surgically non-resectable, recurrent melanoma, usually of cutaneous metastases. The complete response (CR) rate has been reported to be ~20% with a median of ~9 months to achieve it. In real-world practice, decrease of tumor size often occurs rapidly within the first 2-3 months, while improvement of the pigmentation takes several more months. Such clinical observation of lasting pigmentation could be explained by tumorous melanosis-a histopathological term referring to the presence of a melanophage-rich inflammatory infiltrate without remaining viable tumor cells. Herein, we report six patients with metastatic cutaneous melanoma who were treated with T-VEC. Biopsies were performed after observing clinical responses in the injected tumors. Pathological evaluation demonstrated non-viable or absent tumor tissue with tumorous melanosis in all cases. To accurately assess response to therapy and potentially decrease unnecessary additional T-VEC treatments, serial biopsy of 'stable' lesions should be considered to assess the presence or absence of viable tumor.
替莫唑胺（T-VEC）已成为手术不可切除、复发性黑色素瘤的一种越来越受欢迎的治疗选择，通常为皮肤转移。据报道，完全缓解（CR）率约为 20%，中位时间约为 9 个月。在实际实践中，肿瘤大小的缩小通常在最初的 2-3 个月内迅速发生，而色素沉着的改善则需要更多的几个月。这种持久色素沉着的临床观察可以用瘤性黑色素沉着来解释，这是一个组织病理学术语，指的是存在富含噬黑素细胞的炎症浸润，而没有存活的肿瘤细胞。在此，我们报告了 6 例接受 T-VEC 治疗的转移性皮肤黑色素瘤患者。在观察到注射肿瘤的临床反应后进行了活检。所有病例的病理评估均显示无存活或不存在肿瘤组织，伴有瘤性黑色素沉着。为了准确评估治疗反应并可能减少不必要的额外 T-VEC 治疗，应考虑对“稳定”病变进行连续活检，以评估是否存在存活肿瘤。
