It's possible, but with extreme difficulty.
You have to know where in memory the "file" is. But, chances are really good you're not going to find the "file" as a nice single object, like a string, in memory. In any case, you have to know how the application represents the file in memory and how to change whatever you need to change, poking your changes in byte by byte.
As an example, if the application stores a string in memory as a BSTR, you can add stuff to the end of the string, but you also have to go back and poke in a new length for the string just before the beginning of the string data.
You can open another process for kind of like a file, using the WinAPI function
OpenProcess[
^] and
ReadProcessMemory[
^]. You can also write bytes back with
WriteProcessMemory[
^].