Premedication

[Lisa Kottschade]

How many of you pre-medicate with anti-pyretics prior to T-VEC administration? For those that do, what have been your results (i.e less fever/chills, etc.).

Thank you!
Lisa

[Virginia Seery]

We premedicate with acetaminophen and/or ibuprofen prior to TVEC if not contraindicated. I recommend the patient continue this for the first 24-48 hours if feeling flu-like. I think it helps based on patient reports of how they feel when they forget to take it. There also seems to be great variability in degree of side effects among patients. Anecdotally, I have seen fewer side effects in elderly patients (similar to ICI’s), presumably due to a less robust immune system. If a patient has nausea, I will also premedicate with antiemetics.

[Suzanne McGettigan]

I do not routinely premedicate prior to TVEC.
However, if a patient has experienced significant flu-like symptoms following a treatment, then would advise them to take acetominophen/ibuprofen for the first 24-48 hours to prevent similar symptoms with subsequent treatments. These symptoms do seem to lessen over time.

There is one exception to that. Patients who have developed adrenal insufficiency, from a prior immunotherapy treatment, do seem more prone to these flu-like symptoms. Additionally, their adrenal glands cannot compensate for the sick-day/physiologic stress of these symptoms. Therefore, in those patients, I do have them premedicate and take anti-pyretics for the first 24 hours following TVEC administration. Additionally, they sometimes do have to follow their sick-day rules for the day of the TVEC treatment and possibly the next day.

[Krista Rubin]

Our clinic has limited TVEC administrations to one day a week, so my fellow NP Riley does all of the administrations one day. Since I am not familiar with the ins and outs of treatment/management, the above information was very informative. And Suzanne, thanks for the superimportant reminder about managing those with AI.

[Kathleen Madden]

We do not routinely premedicate either unless with the first or a subsequent dose there have been adverse events experienced. When we do premed and manage post injection sx we typically use tylenol or ibuprofen and benadryl 25mg since the gmcsf component often creates a cytokine release which causes the elevated temps and chills / flu-like sx.
We will have a patient premed day of, then remedicate every 8 hours for up to 48 hours as needed, but definitely the first 24 hours. On a very rare occassion we have use low dose dex for a pt who atypically went up to 105, he was on concurrent pembro.

Suzanne, great spotlight on ICI induced AI- thank you for that reminder!

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