Defining optimal oncolytic virus treatment and diagnostics in high risk melanoma patients

Stahlie, E.H.A. (2023)

Doctoral Thesis

This thesis aims to improve the treatment of patients with stage III melanoma. The first part describes different aspects of treatment with Talimogene Laherparepvec (T-VEC), a genetically modified herpes virus, which is used as oncolytic immunotherapy for skin and lymph node metastases in melanoma patients. We show that patients with a low tumor burden have the best outcomes, suggesting T-VEC should be used earlier on in the course of the disease. We present a prediction model, allowing a more accurate selection of patients for T-VEC monotherapy. Two studies focused on the use of T-VEC in clinical practice and the results allowed us to make recommendations on the use of PET/CT and dermoscopy during T-VEC treatment.

Part two focuses on the value of surveillance and screening imaging in high-risk melanoma patients. We show that FDG-PET/CT is a valuable imaging tool to detect recurrence after complete resection of stage III disease, even shortly after surgery (before starting adjuvant therapy). Finally, we conclude that nodal staging with US as adjunct to SLNB is useful in the work- up of stage IIB/C melanoma, as it can lead to alterations in treatment and prevent unnecessary surgery.

• Melanoma
• Talimogene Laherparepvec
• Immunotherapy
• Dermoscopy
• Oncolytic
• Response rate
• Surveillance
• Screening
• High-risk melanoma
• PET/CT

• All authors: Stahlie, E.H.A.
• Supervisor: Wouters, M.W.J.M.
• Co-supervisor: Akkooi, A.C.J. van
• Committee: Hage, J.A. van der; Kapiteijn, H.W.; Bekkenk, M.W.; Verhoef, C.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2023-04-19
• ISBN (print): 9789464830194