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Cariti F, Caivano F, de Robertis V, Dadduzio S, Guarino P, Barbara F, Pontillo V, Russo C, Plantone F, Barbara M. Electrochemotherapy as palliative care in patients with local or metastatic recurrence of head and neck cancer: review of state of the art. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S37-S41. [PMID: 38745515 PMCID: PMC11098543 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 01/28/2024] [Indexed: 05/16/2024]
Abstract
Head and neck cancers are mostly represented by squamous cell carcinoma. Despite effective treatment of primary tumours, local recurrences and metastases are frequent, with up to a 60% risk of local and 30% of distant failure. Moreover, second primary tumours sometimes occur in these patients (2-3% per year). Treatment of recurrences, metastases, and second primary tumours can be extremely challenging for Otorhinolaryngologists, especially in patients who have already been treated with radiotherapy, previous surgery, or both. Electrochemotherapy represents an effective and valid option in these cases.
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Affiliation(s)
- Francesco Cariti
- Otolaryngology and Head and Neck Unit, Ospedale “Mons. Dimiccoli”, Barletta, Italy
| | - Francesca Caivano
- Otolaryngology and Head and Neck Unit, Policlinico di Bari, Bari, Italy
| | | | - Salvatore Dadduzio
- Otolaryngology and Head and Neck Unit, Ospedale “Mons. Dimiccoli”, Barletta, Italy
| | - Pierre Guarino
- Otolaryngology and Head and Neck Unit, Ospedale Civile Santo Spirito, Pescara, Italy
| | - Francesco Barbara
- Otolaryngology and Head and Neck Unit, Policlinico di Bari, Bari, Italy
| | - Vito Pontillo
- Otolaryngology and Head and Neck Unit, Policlinico di Bari, Bari, Italy
| | - Cosimo Russo
- Otolaryngology and Head and Neck Unit, Ospedale Di Venere, Bari, Italy
| | | | - Michele Barbara
- Otolaryngology and Head and Neck Unit, Ospedale Di Venere, Bari, Italy
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Morozas A, Malyško-Ptašinskė V, Kulbacka J, Ivaška J, Ivaškienė T, Novickij V. Electrochemotherapy for head and neck cancers: possibilities and limitations. Front Oncol 2024; 14:1353800. [PMID: 38434679 PMCID: PMC10905418 DOI: 10.3389/fonc.2024.1353800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Head and neck cancer continues to be among the most prevalent types of cancer globally, yet it can be managed with appropriate treatment approaches. Presently, chemotherapy and radiotherapy stand as the primary treatment modalities for various groups and regions affected by head and neck cancer. Nonetheless, these treatments are linked to adverse side effects in patients. Moreover, due to tumor resistance to multiple drugs (both intrinsic and extrinsic) and radiotherapy, along with numerous other factors, recurrences or metastases often occur. Electrochemotherapy (ECT) emerges as a clinically proven alternative that offers high efficacy, localized effect, and diminished negative factors. Electrochemotherapy involves the treatment of solid tumors by combining a non-permeable cytotoxic drug, such as bleomycin, with a locally administered pulsed electric field (PEF). It is crucial to employ this method effectively by utilizing optimal PEF protocols and drugs at concentrations that do not possess inherent cytotoxic properties. This review emphasizes an examination of diverse clinical practices of ECT concerning head and neck cancer. It specifically delves into the treatment procedure, the choice of anti-cancer drugs, pre-treatment planning, PEF protocols, and electroporation electrodes as well as the efficacy of tumor response to the treatment and encountered obstacles. We have also highlighted the significance of assessing the spatial electric field distribution in both tumor and adjacent tissues prior to treatment as it plays a pivotal role in determining treatment success. Finally, we compare the ECT methodology to conventional treatments to highlight the potential for improvement and to facilitate popularization of the technique in the area of head and neck cancers where it is not widespread yet while it is not the case with other cancer types.
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Affiliation(s)
- Arnoldas Morozas
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
| | | | - Julita Kulbacka
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
- Department of Molecular and Cellular Biology, Wroclaw Medical University, Wroclaw, Poland
| | - Justinas Ivaška
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tatjana Ivaškienė
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
| | - Vitalij Novickij
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
- Faculty of Electronics, Vilnius Gediminas Technical University, Vilnius, Lithuania
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3
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Bastrup FA, Vissing M, Gehl J. Electrochemotherapy with intravenous bleomycin for patients with cutaneous malignancies, across tumour histology: a systematic review. Acta Oncol 2022; 61:1093-1104. [DOI: 10.1080/0284186x.2022.2110385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Freya A. Bastrup
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mille Vissing
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Gehl
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Tiefenbach M, Schneider G, Riemann R, Symeou L, Bohr C, Lippert B. [Electrochemotherapy in oto-rhino-laryngology in Germany]. Laryngorhinootologie 2022; 101:195-205. [PMID: 35021242 DOI: 10.1055/a-1722-3252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Magnus Tiefenbach
- Hals-Nasen-Ohrenklinik, Am Gesundbrunnen 20-26, SLK-Kliniken, Heilbronn, Germany
| | | | | | - Luisa Symeou
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Christopher Bohr
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Burkard Lippert
- Hals-Nasen-Ohrenklinik, Am Gesundbrunnen 20-26, SLK-Kliniken, Heilbronn, Germany
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Riva G, Salonia L, Fassone E, Sapino S, Piano F, Pecorari G. Quality of Life in Electrochemotherapy for Cutaneous and Mucosal Head and Neck Tumors. J Clin Med 2021; 10:jcm10194366. [PMID: 34640382 PMCID: PMC8509577 DOI: 10.3390/jcm10194366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Primary or recurrent head and neck cancer of skin or mucosa represents a challenge for clinicians and could be debilitating for the patient. Electrochemotherapy (ECT) emerged as a local ablative procedure for cutaneous and mucosal head and neck tumors. The aim of this observational study was the evaluation of quality of life (QoL) after ECT in patients without other surgical or radiation options as curative treatment. MATERIALS AND METHODS The procedure was performed according the ESOPE (European Standard Operating procedure of Electrochemotherapy) protocol. Twenty-seven patients were evaluated before ECT (T0) and 1 (T1), 3 (T2), and 6 (T3) months after the procedure. QoL was assessed by means of the EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires. RESULTS The objective tumor response rate was 48% (11% CR, 37% PR). Bleeding control was achieved in 7/7 patients who experienced bleeding prior to ECT. QoL improvement was observed after the procedure. In particular, global health status and social functioning were higher after ECT (p 0.026 and 0.043), while pain, pain-killers use and appetite loss decreased (p 0.045, 0.025 and 0.002). CONCLUSION ECT represents a safe and effective treatment for skin and mucosal head and neck tumors without other curative options. It ensures a good pain and bleeding control without worsening of QoL.
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Affiliation(s)
- Giuseppe Riva
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.F.); (S.S.); (F.P.); (G.P.)
- Correspondence:
| | - Laura Salonia
- Division of Otorhinolaryngology, Santa Croce Hospital, 10024 Moncalieri, Italy;
| | - Elisabetta Fassone
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.F.); (S.S.); (F.P.); (G.P.)
| | - Silvia Sapino
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.F.); (S.S.); (F.P.); (G.P.)
| | - Fabrizio Piano
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.F.); (S.S.); (F.P.); (G.P.)
| | - Giancarlo Pecorari
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.F.); (S.S.); (F.P.); (G.P.)
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Cucu CI, Giurcăneanu C, Popa LG, Orzan OA, Beiu C, Holban AM, Grumezescu AM, Matei BM, Popescu MN, Căruntu C, Mihai MM. Electrochemotherapy and Other Clinical Applications of Electroporation for the Targeted Therapy of Metastatic Melanoma. MATERIALS 2021; 14:ma14143985. [PMID: 34300902 PMCID: PMC8305146 DOI: 10.3390/ma14143985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/10/2021] [Accepted: 07/11/2021] [Indexed: 12/21/2022]
Abstract
Electrochemotherapy (ECT) is an effective bioelectrochemical procedure that uses controlled electrical pulses to facilitate the increase of intracellular concentration of certain substances (electropermeabilization/ reversible electroporation). ECT using antitumor drugs such as bleomycin and cisplatin is a minimally invasive targeted therapy that can be used as an alternative for oncologic patients not eligible for surgery or other standard therapies. Even though ECT is mainly applied as palliative care for metastases, it may also be used for primary tumors that are unresectable due to size and location. Skin neoplasms are the main clinical indication of ECT, the procedure reporting good curative results and high efficiency across all tumor types, including melanoma. In daily practice, there are many cases in which the patient’s quality of life can be significantly improved by a safe procedure such as ECT. Its popularity must be increased because it has a safe profile and minor local adverse reactions. The method can be used by dermatologists, oncologists, and surgeons. The aim of this paper is to review recent literature concerning electrochemotherapy and other clinical applications of electroporation for the targeted therapy of metastatic melanoma.
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Affiliation(s)
- Corina Ioana Cucu
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Călin Giurcăneanu
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
- Correspondence: ; Tel.: +40-727-173-767
| | - Olguța Anca Orzan
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Cristina Beiu
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Alina Maria Holban
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest, 030018 Bucharest, Romania;
- Research Institute of the University of Bucharest, 050657 Bucharest, Romania
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 1-7 Polizu Street, 011061 Bucharest, Romania;
| | - Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 1-7 Polizu Street, 011061 Bucharest, Romania;
| | - Bogdan Mircea Matei
- Department of Biophysics and Cellular Biotechnology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Marius Nicolae Popescu
- Department of Physical and Rehabilitation Medicine, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Constantin Căruntu
- Faculty of Medicine, “Titu Maiorescu” University, 22 Dambrovnicului, 031593 Bucharest, Romania;
| | - Mara Mădălina Mihai
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
- Research Institute of the University of Bucharest, 050657 Bucharest, Romania
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7
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Hendel K, Jemec GBE, Haedersdal M, Wiegell SR. Electrochemotherapy with bleomycin for basal cell carcinomas: a systematic review. J Eur Acad Dermatol Venereol 2021; 35:2208-2215. [PMID: 34219303 DOI: 10.1111/jdv.17492] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/06/2021] [Accepted: 06/17/2021] [Indexed: 01/17/2023]
Abstract
Basal cell carcinoma (BCC) is the most common type of cancer and an increasing incidence stimulates the interest in new treatments such as electrochemotherapy (ECT) with bleomycin. This systematic review focuses on literature from the MEDLINE, Embase, Web of Science, and Cochrane databases. Bleomycin-ECT studies (n = 32) were sorted by the level of evidence adjusted for their BCC data only. The studies included a single randomised controlled trial (RCT), 15 uncontrolled clinical trials, three registry studies, six prospective case series and seven retrospective case series. A Cochrane risk-of-bias assessment of the RCT identified some minor concerns but no predicted risk of bias. The studies were also grouped by bleomycin administration routes: intravenous (n = 14), intralesional (n = 9) and mixed reporting/usage (n = 9). A meta-analysis was not conducted due to the lack of RCTs and the heterogeneity of the included studies. The results of the RCT generally reflected the findings of the other included studies and showed a 92% complete response in 65 bleomycin-ECT-treated BCCs after 2 months, improving to 100% after re-treatment, with a low risk of recurrence. Based on the RCT results and overall data, future studies on BCC treatment with bleomycin-ECT should include large RCTs that compare bleomycin-ECT with standard of care, cost analyses, and clinical feasibility.
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Affiliation(s)
- K Hendel
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - M Haedersdal
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - S R Wiegell
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
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8
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Ionna F, Bossi P, Guida A, Alberti A, Muto P, Salzano G, Ottaiano A, Maglitto F, Leopardo D, De Felice M, Longo F, Tafuto S, Della Vittoria Scarpati G, Perri F. Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck: A Big and Intriguing Challenge Which May Be Resolved by Integrated Treatments Combining Locoregional and Systemic Therapies. Cancers (Basel) 2021; 13:2371. [PMID: 34069092 PMCID: PMC8155962 DOI: 10.3390/cancers13102371] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Squamous cell carcinoma of the head and neck (SCCHN) is a complex group of malignancies, posing several challenges to treating physicians. Most patients are diagnosed with a locally advanced disease and treated with strategies integrating surgery, chemotherapy, and radiotherapy. About 50% of these patients will experience a recurrence of disease. Recurrent/metastatic SCCHN have poor prognosis with a median survival of about 12 months despite treatments. In the last years, the strategy to manage recurrent/metastatic SCCHN has profoundly evolved. Salvage treatments (surgery or re-irradiation) are commonly employed in patients suffering from locoregional recurrences and their role has gained more and more importance in the last years. Re-irradiation, using some particularly fractionating schedules, has the dual task of reducing the tumor mass and eliciting an immune response against cancer (abscopal effect). In this review, we will analyze the main systemic and/or locoregional strategies aimed at facing the recurrent/metastatic disease, underlining the enormous importance of the multidisciplinary approach in these types of patients.
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Affiliation(s)
- Franco Ionna
- Otolaryngology Unit, INT IRCCS Foundation G. Pascale, Naples. Via M. Semmola, 80131 Naples, Italy; (F.I.); (G.S.); (F.M.)
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, 25123 Brescia, Italy; (P.B.); (A.A.)
| | - Agostino Guida
- U.O.C. Odontostomatologia, A.O.R.N. Cardarelli, 80131 Naples, Italy;
| | - Andrea Alberti
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, 25123 Brescia, Italy; (P.B.); (A.A.)
| | - Paolo Muto
- Radiation Therapy Unit, INT IRCCS Foundation G Pascale, Via M. Semmola, 80131 Naples, Italy;
| | - Giovanni Salzano
- Otolaryngology Unit, INT IRCCS Foundation G. Pascale, Naples. Via M. Semmola, 80131 Naples, Italy; (F.I.); (G.S.); (F.M.)
| | - Alessandro Ottaiano
- Department of Abdominal Oncology, SSD-Innovative Therapies for Abdominal Cancers, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale” Via M. Semmola, 80131 Naples, Italy;
| | - Fabio Maglitto
- Otolaryngology Unit, INT IRCCS Foundation G. Pascale, Naples. Via M. Semmola, 80131 Naples, Italy; (F.I.); (G.S.); (F.M.)
| | - Davide Leopardo
- Medical Oncology Unit, Azienda Ospedaliera S. Anna e S. Sebastiano, 81100 Caserta, Italy; (D.L.); (M.D.F.)
| | - Marco De Felice
- Medical Oncology Unit, Azienda Ospedaliera S. Anna e S. Sebastiano, 81100 Caserta, Italy; (D.L.); (M.D.F.)
| | - Francesco Longo
- Otolaryngology and Maxillo-Facial Surgery Unit, Ospedale Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Salvatore Tafuto
- Sarcoma and Rare Tumors Medical Oncology Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale” Via M. Semmola, 80131 Naples, Italy;
| | | | - Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, INT IRCCS Foundation G Pascale, Via M. Semmola, 80131 Naples, Italy
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9
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Perri F, Longo F, Fusco R, D’Alessio V, Aversa C, Pavone E, Pontone M, Marciano ML, Villano S, Franco P, Togo G, Fazio GRD, Ordano D, Maglitto F, Salzano G, Maglione MG, Guida A, Ionna F. Electrochemotherapy as a First Line Treatment in Recurrent Squamous Cell Carcinoma of the Oral Cavity and Oropharynx PDL-1 Negative and/or with Evident Contraindication to Immunotherapy: A Randomized Multicenter Controlled Trial. Cancers (Basel) 2021; 13:cancers13092210. [PMID: 34064511 PMCID: PMC8124504 DOI: 10.3390/cancers13092210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/17/2021] [Accepted: 05/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A significant proportion of patients with head and neck squamous cell carcinoma (HNSCC) have advanced-stage disease (stages III to IVB) that do not respond to therapy despite aggressive, site-specific multimodality therapy. A great number of them will develop disease recurrence, with up to 60% risk of local failure and up to 30% risk of distant failure. Therapy can be very demanding for the patient especially when important anatomical structures are involved. For these reasons, therapies that preserve organ functionality in combination with effective local tumor control, like electrochemotherapy (ECT), are of great interest. Until few months ago, systemic cetuximab + platinum-based therapy + 5-fluorouracil represented the standard treatment for HNSCC relapses with a median overall survival of 10.1 months and an objective response rate of 36%. Recently the results of KEYNOTE-048 study were published and a new combination of monoclonal antibody named pembrolizumab and chemotherapy emerged as standard first line therapy of recurrent or metastatic tumor that overexpress tissue PDL-1 (Programmed Death 1 ligand). Nevertheless, a variable percentage from 10 to 15% of patients with recurrent/metastatic disease have a tumor that does not overexpress tissue PDL-1, and therefore, according to the results of the KEYNOTE-048 study, does not benefit from replacement of cetuximab with pembrolizumab. These patients will be treated with the "gold standard": cetuximab, cisplatin/carboplatin and 5-fluorouracil. AIM To verify whether electrochemotherapy performed with bleomycin of HNSCC relapses of the oral cavity and oropharynx (single relapse on T) is able to lead to an increase in the objective response rate in comparison with the systemic treatment with cetuximab + platinum-based therapy + 5-fluorouracil in patients with PDL-1 negative tumors. METHODS The phase IIb study involves the enrolment of 96 patients who meet the inclusion criteria (48 in the control arm and 48 in the treatment arm). The control arm involves the treatment of HNSCC with systemic treatment (cetuximab + platinum-based therapy + 5-fluorouracil). The treatment arm involves the ECT with bleomycin. The primary objective is to verify the objective response rate of patients in the control arm compared to the treatment arm.
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Affiliation(s)
- Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Via M. Semmola, 80131 Naples, Italy; (F.P.); (M.P.); (M.L.M.)
| | - Francesco Longo
- Head and Neck Surgery Unit, Ospedale Casa Sollievo della Sofferenza, S. Giovanni Rotondo, 71013 Foggia, Italy;
| | - Roberta Fusco
- IGEA SpA Medical Division—Oncology, Via Casarea 65, Casalnuovo di Napoli, 80013 Napoli, Italy;
- Correspondence:
| | - Valeria D’Alessio
- IGEA SpA Medical Division—Oncology, Via Casarea 65, Casalnuovo di Napoli, 80013 Napoli, Italy;
| | - Corrado Aversa
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Ettore Pavone
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Monica Pontone
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Via M. Semmola, 80131 Naples, Italy; (F.P.); (M.P.); (M.L.M.)
| | - Maria Luisa Marciano
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Via M. Semmola, 80131 Naples, Italy; (F.P.); (M.P.); (M.L.M.)
| | - Salvatore Villano
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Pierluigi Franco
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Giulia Togo
- School of Specialization in Maxillo-Facial Surgery, University of Naples Federico II, Via Sergio Pansini, 80131 Naples, Italy; (G.T.); (G.R.D.F.); (D.O.)
| | - Gianluca Renato De Fazio
- School of Specialization in Maxillo-Facial Surgery, University of Naples Federico II, Via Sergio Pansini, 80131 Naples, Italy; (G.T.); (G.R.D.F.); (D.O.)
| | - Daniele Ordano
- School of Specialization in Maxillo-Facial Surgery, University of Naples Federico II, Via Sergio Pansini, 80131 Naples, Italy; (G.T.); (G.R.D.F.); (D.O.)
| | - Fabio Maglitto
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Giovanni Salzano
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Maria Grazia Maglione
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Agostino Guida
- U.O.C. Odontostomatologia, AORN A. Cardarelli, 80131 Naples, Italy;
| | - Franco Ionna
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
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Electrochemotherapy in the Treatment of Head and Neck Cancer: Current Conditions and Future Directions. Cancers (Basel) 2021; 13:cancers13061418. [PMID: 33808884 PMCID: PMC8003720 DOI: 10.3390/cancers13061418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Electrochemotherapy (ECT) was first introduced in the late 1980s and was initially used mainly on cutaneous tumors. It has now evolved into a clinically verified treatment approach. Thanks to its high feasibility, it has been extended to treating mucosal and deep-seated tumors, including head and neck cancer (HNC) and in heavily pretreated settings. This review describes current knowledge and data on the use of ECT in various forms of HNCs across different clinical settings, with attention to future clinical and research perspectives. Abstract Despite recent advances in the development of chemotherapeutic drug, treatment for advanced cancer of the head and neck cancer (HNC) is still challenging. Options are limited by multiple factors, such as a prior history of irradiation to the tumor site as well as functional limitations. Against this background, electrochemotherapy (ECT) is a new modality which combines administration of an antineoplastic agent with locally applied electric pulses. These pulses allow the chemotherapeutic drug to penetrate the intracellular space of the tumor cells and thereby increase its cytotoxicity. ECT has shown encouraging efficacy and a tolerable safety profile in many clinical studies, including in heavily pre-treated HNC patients, and is considered a promising strategy. Efforts to improve its efficacy and broaden its application are now ongoing. Moreover, the combination of ECT with recently developed novel therapies, including immunotherapy, represented by immune checkpoint inhibitor (ICI)s, has attracted attention for its potent theoretical rationale. More extensive, well-organized clinical studies and timely updating of consensus guidelines will bring this hopeful treatment to HNC patients under challenging situations.
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Strojan P, Grošelj A, Serša G, Plaschke CC, Vermorken JB, Nuyts S, de Bree R, Eisbruch A, Mendenhall WM, Smee R, Ferlito A. Electrochemotherapy in Mucosal Cancer of the Head and Neck: A Systematic Review. Cancers (Basel) 2021; 13:cancers13061254. [PMID: 33809141 PMCID: PMC7999968 DOI: 10.3390/cancers13061254] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
Electrochemotherapy (ECT) is a local ablative treatment that is based on the reversible electroporation and intracellular accumulation of hydrophilic drug molecules, which greatly increases their cytotoxicity. In mucosal head and neck cancer (HNC), experience with ECT is limited due to the poor accessibility of tumors. In order to review the experience with ECT in mucosal HNC, we undertook a systematic review of the literature. In 22 articles, published between 1998 and 2020, 16 studies with 164 patients were described. Curative and palliative intent treatment were given to 36 (22%) and 128 patients (78%), respectively. The majority of tumors were squamous cell carcinomas (79.3%) and located in the oral cavity (62.8%). In the curative intent group, complete response after one ECT treatment was achieved in 80.5% of the patients, and in the palliative intent group, the objective (complete and partial) response rate was 73.1% (31.2% and 41.9%). No serious adverse events were reported during or soon after ECT and late effects were rare (19 events in 17 patients). The quality-of-life assessments did not show a significant deterioration at 12 months post-ECT. Provided these preliminary data are confirmed in randomized controlled trials, ECT may be an interesting treatment option in selected patients with HNC not amenable to standard local treatment.
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Affiliation(s)
- Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana and Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-1-5879290
| | - Aleš Grošelj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Gregor Serša
- Department of Experimental Oncology, Institute of Oncology Ljubljana and Faculty of Health Sciences, University of Primorska, Izola and Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Christina Caroline Plaschke
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Jan B. Vermorken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, and Department of Medical Oncology, Antwerp University Hospital, 2650 Edegem, Belgium;
| | - Sandra Nuyts
- Department of Oncology, KU Leuven, University of Leuven and Department of Radiation Oncology, UZ Leuven, 3000 Leuven, Belgium;
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109-5010, USA;
| | - William M. Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, FL 32610-0385, USA;
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW 2031, Australia;
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy;
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12
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Electrochemotherapy in the head and neck area: an addition to the treatment armamentarium. Curr Opin Otolaryngol Head Neck Surg 2020; 28:112-117. [PMID: 32102006 DOI: 10.1097/moo.0000000000000609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Electrochemotherapy (ECT) is increasingly used in different settings in head and neck cancer patients when conventional treatment options are not available. RECENT FINDINGS Recent improvements of electroporation and ECT include new advanced electrode probes, the combination with intratumorally injected supraphysiological doses of calcium and an update of the standard operating procedures. SUMMARY ECT is a treatment modality that combines administration of a chemotherapeutic drug, for example, bleomycin, with electroporation therapy (EPT). EPT uses brief, high-intensity, pulsed electrical currents to enhance the uptake of cytotoxic drugs by producing a transient increase in cell wall permeability. ECT increases the effect of cytostatic drugs, is independent on histology of the lesion, enables treatment to previously treated areas, preserves healthy tissue, has no significant side effects (low-dose chemotherapy) and enables repeated treatments. ECT can be combined with other treatment modalities and is an addition to the current treatment options of head and neck cancer. ECT is not only able to palliate symptoms but can also provide complete responses and curation.
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Boosting the Immune Response with the Combination of Electrochemotherapy and Immunotherapy: A New Weapon for Squamous Cell Carcinoma of the Head and Neck? Cancers (Basel) 2020; 12:cancers12102781. [PMID: 32998297 PMCID: PMC7601050 DOI: 10.3390/cancers12102781] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 01/04/2023] Open
Abstract
Simple Summary Squamous cell carcinoma of the head and neck (SCCHN) represents a problem of utmost concern and, for many clinicians and surgeons, an enormous challenge. Currently, new generation immunotherapy which avails of check point inhibitors, namely molecules capable of restoring the host’s immune system strongly depressed by the presence of tumor cells, is gaining increasing importance. Nevertheless, immunotherapy alone is not always effective in some patients, in particular those having a bulky and highly symptomatic disease. These last require the addition of locoregional strategies able to reduce the tumor mass and to assist immunotherapy in producing its effect. Electrochemotherapy (ECT) is a strategy able to associate the electroporation of tumor cells and the simultaneous administration of antineoplastic drugs, so as to concentrate the latter directly in the tumor site. The combination of ECT and immunotherapy could be very effective particularly in patients having a bulky/highly symptomatic SCCHN. Abstract Head and neck squamous cell carcinomas (SCCHN) are not rare malignancies and account for 7% of all solid tumors. Prognosis of SCCHN patients strongly depends on tumor extension, site of onset, and genetics. Advanced disease (recurrent/metastatic) is associated with poor prognosis, with a median overall survival of 13 months. In these patients, immunotherapy may represent an interesting option of treatment, given the good results reached by check-point inhibitors in clinical practice. Nevertheless, only a minor number of patients with advanced disease respond to immunotherapy, and, disease progressions/hyper-progressions are common. The latter could be a very difficult issue, especially in patients having a wide and highly symptomatic head/neck mass. Given the potentiality to boost the immune response of some local modalities, such as electrochemotherapy, a possible future approach may take into account the combination of electrochemotherapy and immunotherapy to treat patients affected by SCCHN, suffering from symptomatic lesions that need rapid debulking.
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Brock RM, Beitel-White N, Davalos RV, Allen IC. Starting a Fire Without Flame: The Induction of Cell Death and Inflammation in Electroporation-Based Tumor Ablation Strategies. Front Oncol 2020; 10:1235. [PMID: 32850371 PMCID: PMC7399335 DOI: 10.3389/fonc.2020.01235] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
New therapeutic strategies and paradigms are direly needed for the treatment of cancer. While the surgical removal of tumors is favored in most cancer treatment plans, resection options are often limited based on tumor localization. Over the last two decades, multiple tumor ablation strategies have emerged as promising stand-alone or combination therapeutic options for patients. These strategies are often employed to treat tumors in areas where surgical resection is not possible or where chemotherapeutics have proven ineffective. The type of cell death induced by the ablation modality is a critical aspect of therapeutic success that can impact the efficacy of the treatment and systemic anti-tumor immune system responses. Electroporation-based ablation technologies include electrochemotherapy, irreversible electroporation, and other modalities that rely on pulsed electric fields to create pores in cell membranes. These pores can either be reversible or irreversible depending on the electric field parameters and can induce cell death either alone or in combination with a therapeutic agent. However, there have been many controversial findings among these technologies as to the cell death type initiated, from apoptosis to pyroptosis. As cell death mechanisms can impact treatment side effects and efficacy, we review the main types of cell death induced by electroporation-based treatments and summarize the impact of these mechanisms on treatment response. We also discuss potential reasons behind the variability of findings such as the similarities between cell death pathways, differences between cell-types, and the variation in electric field strength across the treatment area.
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Affiliation(s)
- Rebecca M. Brock
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, United States
| | - Natalie Beitel-White
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
- Department of Electrical and Computer Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Rafael V. Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Irving C. Allen
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, United States
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Science, Blacksburg, VA, United States
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