Dear Billy,
I am a TVEC+pembro advocate, but I was in a different situation than yours. I only had 1-2 tumours, all local to my lower left leg; pembro dissolved one but the other kept growing, albeit slowly (probably doubled in size in one year). I was going to have to have a third surgery but instead a second opinion recommended adding TVEC (we already knew this was an option) so when the insurance approved, we went for that. After a couple of months the combined treatment started to work and after one year dissolved the tumour, we think.
I thought my lesion was close to the skin but actually it was a little way below, close to the muscle, so my TVEC injections were ultrasound guided. I think at the end the MRI kept detecting tumour but the ultrasound did not, so it was not clear how to inject. In fact this had been a problem for a while as it had become hard to see the tumour on the ultrasound. While I dont have a profile you can read about my experience from my other posts.
My personal bias is that TVEC is good for low tumour burden but less good when many tumours, although you can hope for some abscopal effect. Or perhaps combined w pembro the TVEC kicks the pembro in and then the pembro attacks the other tumours more effectively too. My understanding is that you can inject many tumours simultaneoulsy (not sure about the cost though as it is expensive sadly). Am not sure how practical this is if you needC CT or MRI guidance, as opposed to ultrasound.
Do any of your doctors recommend adding TVEC, or perhaps a second opinion? If combined w pembro may be hard to get the insurance to cover – I ran into difficulties a number of times but my doctor appealed and it was accepted. There are trials of other intraslesionals too, again I like the idea when combined w pembro. If you are looking to buy time (ie the alternative is just continuing pembro while waiting for TIL), then I dont see how adding it can hurt. What about other approaches like LAG3 which came out of ASCO (what does your doctor think?)
In short I am a TVEC (plus pembro) fan (and if your tumours are small maybe TVEC can give the pembro the extra push it needs?); would be much easier if you can do it with ultrasound only (but if they are small then may be hard to find); you can inject many at a time; not sure about insurance; what about trials of other intralesionals or other options?
good luck Mark
.
!! (The only advantage of the new forum format is these emojis so why not use one!!)
