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.
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.
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.