T-VEC treatment cost.

I have just checked my medical bills (or rather I asked my wife to find them and she, after finding the bills for all my other treament years, finally found the right ones)
Putting aside the costs of the doctor, blood work, stuff like that (which are significant but smaller), my bills showed (approximately):

TVEC list price 8,000 member price 5,500
pembro list price 40,000 member price 25,000

As Celeste says, I am not sure these are real numbers, they are so high, and was charged for this every two weeks.

I stopped looking at my bills because when I received the first few they were so high I felt guilty – that so much money was being spent on me for a treatment that my insurance only half-approved (my oncologist was sure they would not approve; then after they approved they changed their mind just I was on my first or second treatment). All this made me depressed. (Even though now I think the numbers are not accurate). I had worked hard for the organization though which employs me, in the past, so this made me feel less guilty.

On the plus side: in my case the TVEC helped make the pembro work; before that I had been on pembro alone and had steady but gradual progression in one site. it was not spreading but pembro was not getting rid of the tumour either. With TVEC the tumour grew then started slowly to shrink. Now it is much smaller or is scar tissue. So in your wife’s case it could well work. I have seen a paper reporting high response rates (bubbles may have posted), but this may be too optimistic.

I think in short the cost is too high, but other injectables might work too (as the other posters recommend) so going for a clinical trial with an injectable (ideally combined with immunotherapy since I think they work well together) could be a good idea. If you can travel economy or if they can send the stuff to brazil, it might work. I think you need to find a trial where the drug company pays.

Am sorry for the bad news, but I think for localized disease injectables plus pembro are a good idea (see texmelanomex posts too please for pv-10), so i hope you can find a trial, and then I hope your wife is in good enough shape to travel economy or economy plus

good luck Mark

Unfortunately it is for each application – sorry. On the bright side, it seems to be cheaper than pembro!
I didnt include the outpatient services – you need a doctor to do the injecting; the TVEC needs to be stored in frozen ice or they need a proper fridge in the pharmacy (my hospital lacked this)
My guess is this would cost 500-1,000 per injection, but I think everything is exaggerated, the hospital must be making money from the markup on the TVEC itself.
If you have three lesions I would guess they multiply by three (sorry)

I did both every two weeks, I think it was mirroring a trial protocol. Doing it every two weeks also means that missing a session is not too fatal, as this means you at least get treatment within four weeks.

I think the advice of others on the board is better. The US medical system is too complicated and expensive to go it alone. Random charges can appear. Try to get into a trial using TVEC another injectable. I cannot say it always works – I was the first using TVEC in my hospital; others followed, but with more burden, and it did not work for them. but your wife’s case seems like it could work.

If pembro is keeping things stable, then it acts as an insurance policy against spread. And my guess is that in my case the TVEC helped the pembro work on the targeted lesions.

I am not out of the woods yet far from it, and my last scans showed a possible recurrence (small), but i did see the TVEC work for me, after 1 year of gradual tumour growth on pembro. So look up other injectable patients like texmelanomex, try and get a trial if you can cover the flight costs.

Good luck Mark

Having already participated in a study you are most likely more than familiar with the clinical trials web site…but just in case – here is a link to their site and the currently recruiting trials for melanoma: https://clinicaltrials.gov/ct2/results?recrs=ab&cond=Melanoma+Stage+IV&term=&cntry=&state=&city=&dist=

Ed makes a good point that intralesionals other than T-VEC may be a reasonable option. Though you may have already seen it, here is a run down from my blog with many links re intralesionals: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2019/01/in-transit-melanoma-metastases-and-pv.html

I don’t know if you or your wife’s docs have considered, or how available it would be to you, but additional tumor testing has been helpful to many melanoma folks who have not responded to conventional melanoma therapy. We have found that in some their tumors have mutations that make them responsive to drugs typically used for other cancers. Maureen’s husband (from this forum) is one example: https://melanoma.org/legacy/find-support/patient-community/mpip-melanoma-patients-information-page/excellent-scans-breast-cancer

And cause, as my family always says – She’s got a song for that!!!! – Here are a few that might hit the right note just now (if you haven’t seen/heard them):
Whatever it takes!!! – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=whatever+it+takes
If you’re going through hell – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2018/09/mantra-and-angels-for-round-2.html
Look up child – https://www.youtube.com/watch?v=7NAYz0zh_Es

I wish there was more I could do. Let me know if there is anything I can help you with. Wishing you and your wife my very best. Celeste