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      Have you seen any instances of ocular herpes in a T-VEC treated patient?


        I have not; though admittedly our experience with T-Vec is fairly limited at this time.


          I have not seen any ocular herpes and we have been doing T-VEC routinely for about two years. I have had two patients develop occasional canker sores during therapy, but both of them had a history of this before starting T-VEC.


          We too have had limited experience with T-VEC but of those patients, the only AE’s we observed were more consistent with flu like symptoms which were treated with benadryl, acetaminophen & sometimes prednisone, but typically for the first 24 hours after the injection. Regarding ocular herpes, my experiences with this is a compication typically associated with an outbreak of shingles along the ophthalmic or maxiallary dermatome which has impacted the eye, but none of these were related to T-Vec. It is possible to aquire a localized herpetic infection from other sources of contact.


            Curious to hear how others would handle:

            Would your practice consider TVEC for a patient with a HISTORY OF recurrent herpetic infections (including ocular) that required daily suppression?


              Hi Krista-

              That is a very interesting question. I think this would be a difficult situation and I would want to reserve this treatment for a setting where other therapies have failed. I would not absolutely rule it out.


                Thanks Lisa. The patient has lesions that are ideal to inject…but the ocular herpes history makes me nervous. Other options are being explored.


                  Krista, my hesitation would be the need for chronic suppression with antivirals as this could potentially decrease the efficacy of T-VEC. However, if other options are limited or exhausted, it would be reasonable to consider with close monitoring for recurrent ocular symptoms.

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