Table 1.
ID | Baseline demography | PVSRIPO Tx | Poststudy Follow-up | |||||||
Baseline stage | BRAF status at screening | Prior therapies (last to most recent) | Total lesions (n) | Timing of last anti-PD-1 Tx relative to PVSRIPO injection (days) | Anti-PD-1 resistance* | irRC† | Additional therapies after PVSRIPO | Progression-free during follow-up Tx? | Time since first PVSRIPO injection | |
Cohort 0: single lesion injected at baseline/day 0 | ||||||||||
1 | IV, M1a | WT | Nivolumab and T-VEC | >5 | ~213 days | Primary | NA‡ | Ipilimumab/nivolumab and maintenance nivolumab | Yes§ | 25 months |
2 | IV, M1b | WT | Pembrolizumab, T-VEC, ipilimumab/nivolumab, investigational agent, and pembrolizumab | 5 | 44 days | Primary | NA‡ | Pembrolizumab, radiation, and binimetinib | No | 23 months (died of disease) |
3 | IIIC | Mut | Vemurafenib and ipilimumab/nivolumab | 3 | ~100 days | Inadequate exposure¶ | NA‡ | Ipilimumab/nivolumab and maintenance nivolumab, radiation, T-VEC, investigational agent plus pembrolizumab | No | 20 months (died of disease) |
Cohort 1: two total lesions injected (one at baseline/day 0 and one on day 21) | ||||||||||
4 | IV, M1a | Mut | >10 therapies, including encorafenib/binimetinib, pembrolizumab, IL-2, and T-VEC | >5 | ~400 days | Secondary | NA‡ | Encorafenib, investigational agent plus pembrolizumab, binimetinib, and abraxane | No | 22 months (died of disease) |
5 | IIIC | Mut | Pembrolizumab, T-VEC, investigational agent/pembro, dabrafenib/trametinib, vemurafenib/cobimetinib, and encorafenib/binimetinib | >5 | ~456 days | Secondary | NA‡ | Pembrolizumab | Yes | 20 months |
6 | IIIC | WT | Nivolumab, T-VEC, ipilimumab/ nivolumab, and radiation | >5 | ~213 days | Primary | NA‡ | Nivolumab and investigational agent | No | 11 months (died of disease) |
Cohort 2: three total lesions injected (one at baseline/day 0, one on day 21, and one on day 42) | ||||||||||
7 | IV, M1b | WT | Ipilimumab/nivolumab, investigational agent/pembrolizumab | >5 | 30 days | Secondary | NA‡ | Pembrolizumab and T-VEC | No | 9 months (died of disease) |
8 | IV, M1a | WT | Nivolumab and pembrolizumab | 4 | 26 days | Primary | irPR** | Pembrolizumab | Yes | 17 months |
9 | IIIC | WT | Nivolumab | >5 | 15 days | Primary | irPR and pCR†† | Nivolumab | Yes | 16 months |
Cohort 3: single lesion injected a total of three times (first at baseline/day 0, second on day 21, and third on day 42) | ||||||||||
10 | IIIC | WT | Ipilimumab/nivolumab nd nivolumab | 3 | 15 days | Secondary | NA | Nivolumab | No | 13 months (died of disease |
11 | IV, M1a | WT | Nivolumab | 2 | ~91 days | Primary | irPR | Nivolumab | Yes | 13 months |
12 | IIIC | WT | Pembrolizumab | >5 | 25 days | Primary | irSD and pCR†† | None | Yes | 10 months |
*Definitions of primary and secondary PD-1 resistance are based on Society for Immunotherapy of Cancer Immunotherapy Resistance Task Force recommendation and assigned per PI chart review.4
†irRC.16
‡Patient was taken off trial due to lack of clinical benefit as determined by the PI and started on additional therapy prior to 4-week confirmation of response.
§After PVSRIPO, patient 1 received four cycles ipilimumab and nivolumab followed by 7 months of maintenance nivolumab; after maintenance cycle 2 of nivolumab, biopsy of two cutaneous lesions showed no viable tumor. Patient 1 has persistent disease in the lymph node basin that was not biopsied but remains stable; all cutaneous/subcutaneous lesions also remain stable.
¶Patient deemed to have had inadequate exposure to determine the type of anti-PD-1 resistance, due to rapid disease progression.
**Confirmation of the irPR was done at 3 weeks instead of 4 weeks.
††Although some pigmented lesions remained, biopsy of injected and non-injected lesions showed no viable melanoma, consistent with pCR.
icPR, immune-related response criteria-confirmed partial response; IL, interleukin; irPR, immune-related response criteria-confirmed partial response; irRC, immune-related response criteria; NA, not assessable; pCR, pathological complete response; PD-1, programmed cell death protein 1; PI, principal investigator; T-VEC, talimogene laherparepvec; Tx, treatment; WT, Wild type.