Talimogene Laherparepvec Response in Recurrent Melanoma During Corticosteroid Replacement for Immune Checkpoint Inhibitor-Induced Adrenal Insufficiency: A Case Report.
Nila N Sabetfakhri, Hibba Tul Rehman, Deborah L Cook et al.
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Case in brief
A 78-year-old man with recurrent in-transit melanoma of the scalp developed secondary adrenal insufficiency after pembrolizumab therapy, necessitating chronic hydrocortisone replacement. He was treated with intralesional talimogene laherparepvec (T-VEC) while on corticosteroids and achieved a complete clinical and histologic response without infectious complications. The patient tolerated the treatment well and remains disease-free at follow-up.
Diagnostic / clinical pearl
This case indicates that physiological corticosteroid replacement may not significantly compromise the efficacy of T-VEC in patients with immune checkpoint inhibitor-induced adrenal insufficiency.
Why it matters
Understanding the safety of T-VEC in patients on corticosteroids can guide treatment decisions for melanoma patients experiencing adrenal insufficiency due to immunotherapy.