1
|
Gabay B, Levkov K, Berl A, Wise J, Shir-Az O, Vitkin E, Saulis G, Shalom A, Golberg A. Electroporation-Based Biopsy Treatment Planning with Numerical Models and Tissue Phantoms. Ann Biomed Eng 2024; 52:71-88. [PMID: 37154990 DOI: 10.1007/s10439-023-03208-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
Molecular sampling with vacuum-assisted tissue electroporation is a novel, minimally invasive method for molecular profiling of solid lesions. In this paper, we report on the design of the battery-powered pulsed electric field generator and electrode configuration for an electroporation-based molecular sampling device for skin cancer diagnostics. Using numerical models of skin electroporation corroborated by the potato tissue phantom model, we show that the electroporated tissue volume, which is the maximum volume for biomarker sampling, strongly depends on the electrode's geometry, needle electrode skin penetration depths, and the applied pulsed electric field protocol. In addition, using excised human basal cell carcinoma (BCC) tissues, we show that diffusion of proteins out of human BCC tissues into water strongly depends on the strength of the applied electric field and on the time after the field application. The developed numerical simulations, confirmed by experiments in potato tissue phantoms and excised human cancer lesions, provide essential tools for the development of electroporation-based molecular markers sampling devices for personalized skin cancer diagnostics.
Collapse
Affiliation(s)
- Batel Gabay
- Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Klimentiy Levkov
- Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Berl
- Department of Plastic Surgery, Meir Medical Center, Kfar Sava, Israel
| | - Julia Wise
- Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Shir-Az
- Department of Plastic Surgery, Meir Medical Center, Kfar Sava, Israel
| | - Edward Vitkin
- Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Gintautas Saulis
- Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | - Avshalom Shalom
- Department of Plastic Surgery, Meir Medical Center, Kfar Sava, Israel
| | - Alexander Golberg
- Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
2
|
Bonadies A, Iorio A, Silipo V, Cota C, Govoni FA, Battista M, Pallara T, Migliano E. Bleomycin Electrochemotherapy of Dermal Cylindroma as an Alternative Treatment in a Rare Adnexal Neoplasm: A Case Report and Literature Review. Biomedicines 2023; 11:2667. [PMID: 37893041 PMCID: PMC10604352 DOI: 10.3390/biomedicines11102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Brooke-Spiegler syndrome is a rare autosomal dominant disorder characterized by the continuous development of multiple benign skin appendage tumors. It is treated usually by repeated standard surgery. Here, we present a case study where electrochemotherapy (ECT) with bleomycin was used as an effective alternative approach in treating advanced dermal cylindromatosis of the head and neck in a patient with Brooke-Spiegler syndrome. PATIENTS AND METHODS A 45-year-old woman presented with multiple recurrent dermal cylindroma lesions on her scalp. Previous treatment consisted of several surgical excisions that resulted in psychological deterioration due to the formation of numerous scars and extensive alopecic areas. ECT was offered to provide tumor removal and disease control and to improve the patient's quality of life. RESULTS The treatment was well tolerated, and a significant reduction in neoplastic tissue was achieved. Importantly, scalp skin condition significantly improved, regaining a fair follicular density on the margins. CONCLUSION This report suggests the feasibility of bleomycin ECT as a less invasive alternative option for controlling multiple scalp cylindroma lesions with cosmetically acceptable results, and improving quality of life.
Collapse
Affiliation(s)
- Antonio Bonadies
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy; (T.P.); (E.M.)
| | - Alessandra Iorio
- Department of Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy; (A.I.); (V.S.)
| | - Vitaliano Silipo
- Department of Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy; (A.I.); (V.S.)
| | - Carlo Cota
- Dermatopathological Laboratory, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy;
| | - Flavio Andrea Govoni
- Department of Maxillofacial Surgery, ACO San Camillo, Forlanini, 00152 Rome, Italy;
| | - Michela Battista
- Scientific & Medical Department, IGEA S.p.A, 41012 Carpi, Italy;
| | - Tiziano Pallara
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy; (T.P.); (E.M.)
| | - Emilia Migliano
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy; (T.P.); (E.M.)
| |
Collapse
|
3
|
Milicevic S, Cemazar M, Ivancic AK, Gasljevic G, Bosnjak M, Sersa G, Peric B. Electrochemotherapy of Melanoma Cutaneous Metastases in Organ Transplant Recipients: A Systematic Review of Preclinical and Clinical Studies. Int J Mol Sci 2023; 24:ijms24098335. [PMID: 37176042 PMCID: PMC10179383 DOI: 10.3390/ijms24098335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Cutaneous melanoma is a highly aggressive form of skin cancer. The development of immune checkpoint inhibitors (ICIs) has revolutionized the management of advanced melanoma, led to durable responses, and improved overall survival. However, the success of ICIs in melanoma treatment is influenced by the tumor microenvironment (TME) which plays a critical role in regulating the immune response to the tumor. Understanding the mechanisms underlying this interaction is crucial to optimizing the efficiency of ICIs. Electrochemotherapy (ECT) has been shown to enhance the efficacy of ICIs in melanoma treatment by inducing tumor cell death and facilitating the release of tumor antigens which can subsequently be recognized and targeted by the immune system. Moreover, ECT has been reported to modulate the TME, leading to increased infiltration of immune cells and a more favorable immunological profile. In this review, we summarize the available knowledge of changes in TME after ECT of melanoma cutaneous metastasis and highlight the differences in tumor-infiltrating immune cells between immunocompetent and immunosuppressed organisms. In addition, we showed that ECT can be an effective and safe procedure for organ transplant recipients. Furthermore, repeated ECT may enhance immune activation and probably induce a bystander effect by trained immunity.
Collapse
Affiliation(s)
- Sara Milicevic
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia
| | - Maja Cemazar
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310 Izola, Slovenia
| | | | - Gorana Gasljevic
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
| | - Masa Bosnjak
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Askerceva Cesta 7, 1000 Ljubljana, Slovenia
| | - Gregor Sersa
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena Pot 5, 1000 Ljubljana, Slovenia
| | - Barbara Peric
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia
| |
Collapse
|
4
|
Barca I, Ferragina F, Kallaverja E, Arrotta A, Cristofaro MG. Electrochemotherapy as an Effective Alternative in the Treatment of Local Advanced Oral Squamous Cell Carcinoma: A Retrospective Analysis of Treated Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5170. [PMID: 36982078 PMCID: PMC10049161 DOI: 10.3390/ijerph20065170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
Advanced oral squamous cell carcinomas represent a major challenge for maxillofacial surgeons, oncologists and radiation therapists. They also account for a large share of healthcare costs. They respond little and/or poorly to conventional therapies (surgery, radiotherapy and chemotherapy). Electrochemotherapy is a new method used as a palliative treatment in patients with advanced cancer of the neck/head region who are not eligible for standard therapies. It combines the use of cytotoxic drugs with the physical principle of electroporation; it effectively controls the tumour locally and preserves organ function. To date, ECT has been little used for oral mucosal tumours, as this is difficult to access for electrodes. We report six cases of advanced oral squamous cell carcinoma treated with electrochemotherapy. This study aims to assess the debulking effect of cancer via ECT in patients with advanced oral squamous cell carcinoma. It also aims to assess the safety and tolerability of this treatment.
Collapse
Affiliation(s)
- Ida Barca
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Francesco Ferragina
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Elvis Kallaverja
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Antonella Arrotta
- Department of Medical and Surgical Sciences, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Maria Giulia Cristofaro
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| |
Collapse
|
5
|
de Castro Cunha RM, Lavalle GE, Nunes FC, de Oliveira AR, de Lima Santos R, de Araújo RB. Canine squamous cell carcinoma: Electrochemotherapy association with surgery and correlation with overall survival. Vet Comp Oncol 2023; 21:240-254. [PMID: 36745052 DOI: 10.1111/vco.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/07/2023]
Abstract
Squamous cell carcinoma (SCC) is an important malignancy in dogs, due to its incidence and clinical presentation, which can be of locally aggressive single or multiple lesions with a metastatic potential. The objective of this investigation was to evaluate SCC response to treatment, anatomopathological and immunohistochemical characteristics, disease-free interval and overall survival time. 54 dogs with histopathologically diagnosed SCC were included in this study. Their mean age was 9.16 years with a range of 1-14 years. Of the 54 animals in the study, 34 (65.4%) had white skin and white fur coats. There was a significant correlation between fur coat colour and the development of tumours in areas of sun exposure (p = .001). Animals with tumours in areas of the body exposed to the sun had longer overall survival time than animals with tumours in areas not associated with sun exposure (p = .001). Surgery combined with electrochemotherapy (ECT) yielded a survival rate 32% higher than using a surgical approach alone (HR = 0.32, p = .038, IC = 0.11-0.94). ECT, with or without surgery, had an objective response rate of 90.9%. Local lymph node and/or distant site metastasis at diagnosis, or at some point during follow-up, occurred in 34.6% (18/52) of animals. Animals with tumours in sun exposed locations had more aggressive histopathological characteristics but had longer overall survival time. This is probably due to individualised therapeutic treatment with both surgery and ECT.
Collapse
Affiliation(s)
- Rúbia Monteiro de Castro Cunha
- Department of Veterinary Clinic and Surgery, Veterinary School, Veterinary Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Gleidice Eunice Lavalle
- Department of Veterinary Clinic and Surgery, Veterinary School, Veterinary Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Ayisa Rodrigues de Oliveira
- Department of Veterinary Pathology, Veterinary School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Renato de Lima Santos
- Department of Veterinary Pathology, Veterinary School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Roberto Baracat de Araújo
- Department of Veterinary Clinic and Surgery, Veterinary School, Veterinary Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| |
Collapse
|
6
|
Heinzelmann J, Hecht S, Vogt AR, Siebolts U, Kaatzsch P, Viestenz A. Repetitive Bleomycin-Based Electrochemotherapy Improves Antitumor Effectiveness in 3D Tumor Models of Conjunctival Melanoma. J Clin Med 2023; 12:jcm12031087. [PMID: 36769736 PMCID: PMC9917688 DOI: 10.3390/jcm12031087] [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: 11/29/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Conjunctival melanoma (CM) is associated with a high rate of local recurrence and poor survival rate. Novel therapeutic options are needed to reduce recurrence rate. The objective of the study was to demonstrate the improved effectiveness of electrochemotherapy (ECT) on CM using repetitive application. METHODS Tumor spheroids of three CM cell lines (CRMM1, CRMM2, CM2005.1) were treated repetitively with ECT using the chemotherapeutic agent bleomycin on days 3, 5, and 7 of culture. Application of bleomycin alone and electroporation alone served as controls. The cytotoxic effect was analyzed on day 10 compared to untreated control using an independent t-test. The spheroid outgrowth rate was measured. RESULT CM tumor spheroid size (median value: 78%, SD: 32%) and viability (median value: 11%, SD: 11%) were dramatically reduced after repetitive ECT treatment (p-value < 0.001). Decreased proliferation capacity (down to 8%) and an increase of apoptotic cells were observed. In most repetitive ECT-treated spheroids, no viable or proliferating cells were detected. Only 33-40% of repetitive ECT-treated spheroids exhibited single outgrowing cells with a delay of time up to 38 days. CONCLUSION Repetitive ECT application effectively induces cytotoxic effects in CM spheroids by inducing apoptosis, inhibiting proliferation and decreasing the percentage of surviving tumor cells. Thus, repetitive ECT results in improved antitumor effectiveness in CM and could be an alternative therapy option.
Collapse
Affiliation(s)
- Joana Heinzelmann
- Department of Ophthalmology, University Hospital Halle-Wittenberg, 06120 Halle, Germany
- Correspondence:
| | - Sabine Hecht
- Department of Ophthalmology, University Hospital Halle-Wittenberg, 06120 Halle, Germany
| | - Alexander Ruben Vogt
- Department of Ophthalmology, University Hospital Halle-Wittenberg, 06120 Halle, Germany
| | - Udo Siebolts
- Institute of Pathology, University Hospital Halle-Wittenberg, 06112 Halle, Germany
- Institute of Pathology, University Hospital Köln, 50996 Köln, Germany
| | - Peter Kaatzsch
- Institute of Pathology, University Hospital Halle-Wittenberg, 06112 Halle, Germany
| | - Arne Viestenz
- Department of Ophthalmology, University Hospital Halle-Wittenberg, 06120 Halle, Germany
| |
Collapse
|
7
|
Malyško-Ptašinskė V, Staigvila G, Novickij V. Invasive and non-invasive electrodes for successful drug and gene delivery in electroporation-based treatments. Front Bioeng Biotechnol 2023; 10:1094968. [PMID: 36727038 PMCID: PMC9885012 DOI: 10.3389/fbioe.2022.1094968] [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: 11/10/2022] [Accepted: 12/28/2022] [Indexed: 01/17/2023] Open
Abstract
Electroporation is an effective physical method for irreversible or reversible permeabilization of plasma membranes of biological cells and is typically used for tissue ablation or targeted drug/DNA delivery into living cells. In the context of cancer treatment, full recovery from an electroporation-based procedure is frequently dependent on the spatial distribution/homogeneity of the electric field in the tissue; therefore, the structure of electrodes/applicators plays an important role. This review focuses on the analysis of electrodes and in silico models used for electroporation in cancer treatment and gene therapy. We have reviewed various invasive and non-invasive electrodes; analyzed the spatial electric field distribution using finite element method analysis; evaluated parametric compatibility, and the pros and cons of application; and summarized options for improvement. Additionally, this review highlights the importance of tissue bioimpedance for accurate treatment planning using numerical modeling and the effects of pulse frequency on tissue conductivity and relative permittivity values.
Collapse
Affiliation(s)
| | - Gediminas Staigvila
- Faculty of Electronics, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Vitalij Novickij
- Faculty of Electronics, Vilnius Gediminas Technical University, Vilnius, Lithuania
- Department of Immunology, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
| |
Collapse
|
8
|
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
| |
Collapse
|
9
|
Campana LG, Quaglino P, de Terlizzi F, Mascherini M, Brizio M, Spina R, Bertino G, Kunte C, Odili J, Matteucci P, MacKenzie Ross A, Schepler H, Clover JAP, Kis E. Health-related quality of life trajectories in melanoma patients after electrochemotherapy: real-world insights from the InspECT register. J Eur Acad Dermatol Venereol 2022; 36:2352-2363. [PMID: 35870122 DOI: 10.1111/jdv.18456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Electrochemotherapy (ECT) effectively controls skin metastases from cutaneous melanoma. OBJECTIVES This study aimed to evaluate health-related quality of life (HRQoL) in melanoma patients pre-/post-ECT and its effect on treatment outcome. METHODS The analysis included prospective data from the International Network for Sharing Practices of ECT register. Following the Standard Operating Procedures, patients received intravenous or intratumoural bleomycin (15,000 IU/m2 ; 1000 IU mL/cm3 ) followed by 100-microsecond, 1000-V/cm electric pulses. Endpoints included response (RECIST v3.0), local progression-free survival (LPFS), toxicity (CTCAE v5.0), and patient-reported HRQoL at baseline, one, two, four and ten months (EuroQol [EQ-5D-3L], including 5-item utility score [EQ-5D] and visual analogue scale for self-reported health state [EQ-VAS]). Comparisons within/between subgroups were made for statistical and minimal important differences (MID). HRQoL scores and clinical covariates were analysed to identify predictors of response in multivariate analysis. RESULTS Median tumour size was 2 cm. Complete response rate, G3 toxicity and one-year LPFS in 378 patients (76% of the melanoma cohort) were 47%, 5%, and 78%. At baseline, age-paired HRQoL did not differ from the general European population. Following ECT, both EQ-5D and EQ-VAS scores remained within MID boundaries, particularly among complete responders. A subanalysis of the EQ-5D items revealed a statistically significant deterioration in pain/discomfort and mobility (restored within four months), and self-care and usual activities (throughout the follow-up) domains. Concomitant checkpoint inhibition correlated with better EQ-5D and EQ-VAS trajectories. Baseline EQ-5D was the exclusive independent predictor for complete response (RR 14.76, p=0.001). CONCLUSIONS HRQoL of ECT melanoma patients parallels the general population and is preserved in complete responders. Transient deterioration in pain/discomfort and mobility and persistent decline in self-care and usual activities may warrant targeted support interventions. Combination with checkpoint inhibitors is associated with better QoL outcomes. Baseline HRQoL provides predictive information which can help identify patients most likely to respond.
Collapse
Affiliation(s)
- L G Campana
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - P Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Italy
| | - F de Terlizzi
- Biophysics Department, IGEA S.p.A., 41012 Carpi, Modena, Italy
| | - M Mascherini
- Department of Surgical Sciences, Polyclinic Hospital San Martino, Genoa, Italy
| | - M Brizio
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Italy
| | - R Spina
- Psychology Unit, University Hospital of Padua, Padua, Italy
| | - G Bertino
- Department of Otolaryngology-Head Neck Surgery, Policlinico San Matteo Foundation IRCCS, Pavia University, Pavia, Italy
| | - C Kunte
- Department of Dermatosurgery and Dermatology, Artemed Fachklinik, Munich, Germany
| | - J Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Trust, London, UK
| | - P Matteucci
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - A MacKenzie Ross
- Department of Plastic and Reconstructive Surgery, St Thomas' Hospital, UK
| | - H Schepler
- Department of Dermatology, University Medical Center, Johannes Gutenberg University KöR, Mainz, Germany
| | - J A P Clover
- Department of Plastic Surgery, Cork University Hospital, Cork, Ireland
- Cancer Research, University College Cork, Cork, Ireland
| | - E Kis
- Department of Dermatology and Allergology, University of Szeged, Hungary
| |
Collapse
|
10
|
Electrochemotherapy of skin metastases from malignant melanoma: a PRISMA-compliant systematic review. Clin Exp Metastasis 2022; 39:743-755. [PMID: 35869314 PMCID: PMC9474499 DOI: 10.1007/s10585-022-10180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
The main treatment of MM metastases are systemic therapies, surgery, limb perfusion, and intralesional talimogene laherparepvec. Electrochemotherapy (ECT) is potentially useful also due to the high response rates recorded in cancers of any histology. No randomized studies comparing ECT with other local therapies have been published on this topic. We analyzed the available evidence on efficacy and toxicity of ECT in this setting. PubMed, Scopus, and Cochrane databases were screened for paper about ECT on MM skin metastases. Data about tumor response, mainly in terms of overall response rate (ORR), toxicity (both for ECT alone and in combination with systemic treatments), local control (LC), and overall survival (OS) were collected. The methodological quality was assessed using a 20-item validated quality appraisal tool for case series. Overall, 18 studies were included in our analysis. In studies reporting “per patient” tumor response the pooled complete response (CR) was 35.7% (95%CI 26.0–46.0%), and the pooled ORR was 80.6% (95%CI 68.7–90.1%). Regarding “per lesion” response, the pooled CR was 53.5% (95%CI 42.1–64.7%) and the pooled ORR was 77.0% (95%CI 56.0–92.6%). One-year LC rate was 80%, and 1-year OS was 67–86.2%. Pain (24.2–92.0%) and erythema (16.6–42.0%) were the most frequent toxicities. Two studies reported 29.2% and 41.6% incidence of necrosis. ECT is effective in terms of tumor response and tolerated in patients with skin metastases from MM, albeit with a wide variability of reported results. Therefore, prospective trials in this setting are warranted.
Collapse
|
11
|
Simultaneous Gemcitabine and Percutaneous CT-Guided Irreversible Electroporation for Locally Advanced Pancreatic Cancer. JOURNAL OF ONCOLOGY 2022; 2022:3523769. [PMID: 35747123 PMCID: PMC9213186 DOI: 10.1155/2022/3523769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 11/24/2022]
Abstract
Background Irreversible electroporation (IRE) is a new local ablation technique for pancreatic cancer. The aim of this study is to analyse the safety and effectiveness of simultaneous gemcitabine and percutaneous CT-guided IRE for locally advanced pancreatic cancer (LAPC). Materials and Methods From October 2016 to January 2018, 61 patients with LAPC who received simultaneous gemcitabine and IRE therapy (GEM-IRE group, n = 31) or IRE alone therapy (IRE group, n = 30). Routine intravenous gemcitabine chemotherapy was performed 2 weeks after IRE in both groups. Results Technical success rates were 90.0% (27/30) and 93.3% (28/30) in the GEM-IRE and IRE groups. Compared with the IRE group, the GEM-IRE group exhibited longer overall survival (OS), local tumor progression free survival (LTPFS), and distant disease free survival (DDFS) from IRE (OS, 17.1 vs. 14.2 months, p=0.031; LTPFS, 14.6 vs. 10.2 months, p=0.045; DDFS, 15.4 vs. 11.7 months, p=0.071). Multivariate Cox regression analysis results suggested that tumor volume ≤37 cm3 and simultaneous gemcitabine with IRE were significant independent prognostic factors of OS, LTPFS, and DDFS. Four major adverse reactions occurred; all of them were resolved after symptomatic treatment. Conclusions Simultaneous gemcitabine and percutaneous CT-guided IRE therapy model was effective and well-tolerated therapeutic strategy in LAPC patients.
Collapse
|
12
|
Kraemer MM, Tsimpaki T, Berchner-Pfannschmidt U, Bechrakis NE, Seitz B, Fiorentzis M. Calcium Electroporation Reduces Viability and Proliferation Capacity of Four Uveal Melanoma Cell Lines in 2D and 3D Cultures. Cancers (Basel) 2022; 14:cancers14122889. [PMID: 35740554 PMCID: PMC9221408 DOI: 10.3390/cancers14122889] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 12/07/2022] Open
Abstract
Simple Summary Calcium electroporation (CaEP) is an innovative anti-tumor treatment modality that induces cell death by introducing supraphysiological concentrations of calcium into cells with a limited effect on normal cells. The objective of the present study is to assess the effect of CaEP in uveal melanoma (UM) cell lines in comparison to electrochemotherapy (ECT) with bleomycin using 2D monolayer cell cultures as well as 3D tumor spheroid models in four different UM cell lines. The morphological changes of the spheroids, the cell viability, growth rate as well as the cytotoxic effect of electroporation (EP) with calcium chloride and bleomycin were evaluated with various drug concentrations. The results of CaEP and ECT both suggest a comparable dose-dependent reduction in cell viability and proliferation rate in all tested 2D cell lines and 3D tumor spheroids. These data point out that CaEP is an established anticancer treatment causing cell death by ATP depletion in in vitro and in vivo, representing an efficient alternative therapy with a lower cytotoxic potency for the local UM tumor control. Abstract Electrochemotherapy (ECT) is the combination of transient pore formation following electric pulse application with the administration of cytotoxic drugs, which enhances the cytotoxic effect of the applied agent due to membrane changes and permeabilization. Although EP represents an established therapeutic option for solid malignancies, recent advances shift to the investigation of non-cytotoxic agents, such as calcium, which can also induce cell death. The present study aims to evaluate the cytotoxic effect, the morphological changes in tumor spheroids, the effect on the cell viability, and the cell-specific growth rate following calcium electroporation (CaEP) in uveal melanoma (UM) 2D monolayer cell cultures as well as in 3D tumor spheroid models. The experiments were conducted in four cell lines, UM92.1, Mel270, and two primary UM cell lines, UPMD2 and UPMM3 (UPM). The 2D and 3D UM cell cultures were electroporated with eight rectangular pulses (100 µs pulse duration, 5 Hz repetition frequency) of a 1000 V/cm pulse strength alone or in combination with 0.11 mg/mL, 0.28 mg/mL, 0.55 mg/mL or 1.11 mg/mL calcium chloride or 1.0 µg/mL or 2.5 µg/mL bleomycin. The application of calcium chloride alone induced an ATP reduction only in the UM92.1 2D cell cultures. Calcium alone had no significant effect on ATP levels in all four UM spheroids. A significant decrease in the intracellular adenosine triphosphate (ATP) level was documented in all four 2D and 3D cell cultures for both CaEP as well as ECT with bleomycin. The results suggest a dose-dependent ATP depletion with a wide range of sensitivity among the tested UM cell lines, control groups, and the applied settings in both 2D monolayer cell cultures and 3D tumor spheroid models. The colony formation capacity of the cell lines after two weeks reduced significantly after CaEP only with 0.5 mg/mL and 1.1 mg/mL, whereas the same effect could be achieved with both applied bleomycin concentrations, 1.0 µg/mL and 2.5 µg/mL, for the ECT group. The specific growth rate on day 7 following CaEP was significantly reduced in UM92.1 cell lines with 0.5 and 1.1 mg/mL calcium chloride, while Mel270 showed a similar effect only after administration of 1.1 mg/mL. UM92.1 and Mel270 spheroids exhibited lower adhesion and density after CaEP on day three in comparison to UPM spheroids showing detachment after day 7 following treatment. CaEP and bleomycin electroporation significantly reduce cell viability at similar applied voltage settings. CaEP may be a feasible and inexpensive therapeutic option for the local tumor control with fewer side effects, in comparison to other chemotherapeutic agents, for the treatment of uveal melanoma. The limited effect on normal cells and the surrounding tissue has already been investigated, but further research is necessary to clarify the effect on the surrounding tissue and to facilitate its application in a clinical setting for the eye.
Collapse
Affiliation(s)
- Miriam M. Kraemer
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany; (M.M.K.); (T.T.); (U.B.-P.); (N.E.B.)
| | - Theodora Tsimpaki
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany; (M.M.K.); (T.T.); (U.B.-P.); (N.E.B.)
| | - Utta Berchner-Pfannschmidt
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany; (M.M.K.); (T.T.); (U.B.-P.); (N.E.B.)
| | - Nikolaos E. Bechrakis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany; (M.M.K.); (T.T.); (U.B.-P.); (N.E.B.)
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, 66421 Homburg, Germany;
| | - Miltiadis Fiorentzis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany; (M.M.K.); (T.T.); (U.B.-P.); (N.E.B.)
- Correspondence: ; Tel.: +49-723-2900
| |
Collapse
|
13
|
Lee D, Naikar JS, Chan SSY, Meivita MP, Li L, Tan YS, Bajalovic N, Loke DK. Ultralong recovery time in nanosecond electroporation systems enabled by orientational-disordering processes. NANOSCALE 2022; 14:7934-7942. [PMID: 35603889 DOI: 10.1039/d1nr07362a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The growing importance of applications based on molecular medicine and genetic engineering is driving the need to develop high-performance electroporation technologies. The electroporation phenomenon involves disruption of the cell for increasing membrane permeability. Although there is a multitude of research focused on exploring new electroporation techniques, the engineering of programming schemes suitable for these electroporation methods remains a challenge. Nanosecond stimulations could be promising candidates for these techniques owing to their ability to generate a wide range of biological responses. Here we control the membrane permeabilization of cancer cells using different numbers of electric-field pulses through orientational disordering effects. We then report our exploration of a few-volt nanosecond alternating-current (AC) stimulation method with an increased number of pulses for developing electroporation systems. A recovery time of ∼720 min was achieved, which is above the average of ∼76 min for existing electroporation methods using medium cell populations, as well as a previously unreported increased conductance with an increase in the number of pulses using weak bias amplitudes. All-atom molecular dynamics (MD) simulations reveal the orientation-disordering-facilitated increase in the degree of permeabilization. These findings highlight the potential of few-volt nanosecond AC-stimulation with an increased number of pulse strategies for the development of next-generation low-power electroporation systems.
Collapse
Affiliation(s)
- Denise Lee
- Department of Science, Mathematics and Technology, Singapore University of Technology and Design, Singapore 487372.
| | - J Shamita Naikar
- Office of Innovation, Changi General Hospital, Singapore, 529889
| | - Sophia S Y Chan
- Department of Science, Mathematics and Technology, Singapore University of Technology and Design, Singapore 487372.
| | - Maria Prisca Meivita
- Department of Science, Mathematics and Technology, Singapore University of Technology and Design, Singapore 487372.
| | - Lunna Li
- Department of Science, Mathematics and Technology, Singapore University of Technology and Design, Singapore 487372.
| | - Yaw Sing Tan
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore 138671
| | - Natasa Bajalovic
- Department of Science, Mathematics and Technology, Singapore University of Technology and Design, Singapore 487372.
| | - Desmond K Loke
- Department of Science, Mathematics and Technology, Singapore University of Technology and Design, Singapore 487372.
- Office of Innovation, Changi General Hospital, Singapore, 529889
| |
Collapse
|
14
|
Petrelli F, Ghidini A, Simioni A, Campana LG. Impact of electrochemotherapy in metastatic cutaneous melanoma: a contemporary systematic review and meta-analysis. Acta Oncol 2022; 61:533-544. [PMID: 34889156 DOI: 10.1080/0284186x.2021.2006776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/11/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Electrochemotherapy (ECT) harnesses electric pulses to enhance cytotoxic drug delivery into tumors and has entered the armamentarium to treat superficially metastatic melanoma. We performed a systematic review and meta-analysis to assess treatment patterns and patient outcomes. METHODS PubMed, Medline, Embase, and the Cochrane Library databases were queried for publication from inception to September 2020. Primary outcome measures were overall and complete response rate (ORR and CRR); secondary outcomes included local control rate (LCR) and overall survival (OS). RESULTS Twenty-seven studies met the selection criteria for a total of 1161 individuals (mean age 71 years) and 5308 tumors (weighted mean size 14 mm). The majority of patients (n = 1124) underwent bleomycin-ECT. Aggregate ORR was 77.6% (95% confidence interval [CI] 71.0 - 83.2%) and CRR 48% (95% CI 42 - 54%), with no significant difference between the route of bleomycin administration (ORR, 69.2 vs. 81.9% following intravenous or intratumoral bleomycin, p = .37) and tumor size (p = .69). When reported (n = 8 studies), 1- and 2-year LCR ranged from 54 to 89% and 72 to 74%, respectively, and 1-year OS (n = 3 studies) from 67 to 89%. CONCLUSIONS ECT with either intratumoral or intravenous bleomycin confers a high therapeutic response in cutaneous metastatic melanoma. Moderate evidence supports its low toxicity and durability of local control.HighlightsElectrochemotherapy (ECT) is associated with a 77% overall response rate (ORR).Intravenous and intratumoral bleomycin are equally effective.There are no relevant toxicity concerns.One-year local tumor control rate ranges from 54 to 89%.Current literature has significant variation in reporting.
Collapse
Affiliation(s)
| | | | - Andrea Simioni
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | | |
Collapse
|
15
|
Claussen CS, Moir G, Bechara FG, Orlando A, Matteucci P, Mowatt D, Clover AJP, Mascherini M, Gehl J, Muir T, Sersa G, Groselj A, Odili J, Giorgione R, Campana LG, Bertino G, Curatolo P, Banerjee S, Kis E, Quaglino P, Pritchard-Jones R, De Terlizzi F, Grischke EM, Kunte C. Prospektive Kohortenstudie von InspECT zur Sicherheit und Wirksamkeit der Elektrochemotherapie bei Hauttumoren und Metastasen in Abhängigkeit von Ulzeration. J Dtsch Dermatol Ges 2022; 20:470-482. [PMID: 35446500 DOI: 10.1111/ddg.14699_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022]
Abstract
HINTERGRUND Elektrochemotherapie (ECT) ist eine wirksame lokale Behandlung von Hauttumoren. Ziel dieser Studie war es, die Wirksamkeit der ECT bei ulzerierten gegenüber nichtulzerierten Tumoren zu vergleichen und den Effekt auf tumorassoziierte Symptome zu untersuchen. METHODIK 20 Krebszentren des International Network for Sharing Practices on Electrochemotherapy (InspECT) sammelten prospektiv Daten. Die ECT wurde nach dem ESOPE-Protokoll durchgeführt. Das Therapieansprechen wurde anhand der Entwicklung der Läsionsgröße bewertet. Zusätzlich wurden Schmerzen, Symptome, Leistungsstatus (ECOG-Index) und Gesundheitszustand (EQ-5D-Fragebogen) untersucht. ERGEBNISSE 716 Patienten mit ulzerierten (n = 302) und nichtulzerierten (n = 414) Hauttumoren und Metastasen wurden eingeschlossen (Mindest-Nachsorge 45 Tage). Nicht-ulzerierte Läsionen sprachen besser auf die ECT an als ulzerierte Läsionen (vollständiges Ansprechen: 65 % gegenüber 51 %, p = 0,0061). Nur 38 % (115/302) der Patienten mit ulzerierten Läsionen vor der ECT wiesen bei der letzten Nachuntersuchung ulzerierte Läsionen auf. Patienten mit ulzerierten Läsionen berichteten über stärkere Schmerzen und schwerere Symptome im Vergleich zu Patienten mit nichtulzerierten Läsionen, die sich nach der ECT signifikant und kontinuierlich besserten. Bei Patienten mit nichtulzerierten Läsionen hingegen nahmen die Schmerzen während der Behandlung vorübergehend zu. Es wurden keine schwerwiegenden Nebenwirkungen beobachtet. SCHLUSSFOLGERUNGEN Die ECT ist eine sichere und wirksame lokale Behandlung von Hauttumoren. Während die ECT die Symptome insbesondere bei Patienten mit ulzerierten Läsionen verbessert, sollte auf Basis der Daten die Implementation eines perioperativen Schmerzmanagements besonders bei nichtulzerierten Läsionen während der ECT erwogen werden.
Collapse
Affiliation(s)
- Carla Sophie Claussen
- Department of Dermatosurgery and Dermatology, Artemed Clinic of Munich, Munich, Germany
| | - Graeme Moir
- The Royal London Hospital & QMUL, Bart's Health NHS Trust, Department of Cutaneous Medicine & Surgery, London, United Kingdom
| | - Falk G Bechara
- Department of Dermatologic Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Antonio Orlando
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Paolo Matteucci
- Department of Plastic surgery, Castle Hill Hospital, Cottingham, United Kingdom
| | - David Mowatt
- Plastic Surgery Department, The Christie Hospital NHS Foundation trust, Manchester, United Kingdom
| | - Anthony James P Clover
- Department of Plastic Surgery, Cork University Hospital, Cork, Ireland.,Cancer Research@UCC, Western Gateway Building, University College Cork, Cork, Ireland
| | - Matteo Mascherini
- Clinica Chirurgica 1 - Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), 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
| | - Tobian Muir
- Plastic Surgery Department, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Joy Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Luca Giovanni Campana
- Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.,Department of Surgery, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Pietro Curatolo
- Department of Dermatology and Plastic Surgery, Dermatologic Clinic, University of Roma "La Sapienza", Roma, Italy
| | - Shramana Banerjee
- Division of Surgery and interventional Science, University College London, London, United Kingdom
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | | | - Eva-Maria Grischke
- Department of Gynecology, University Hospital of Tübingen, Tübingen, Germany
| | - Christian Kunte
- Department of Dermatosurgery and Dermatology, Artemed Clinic of Munich, Munich, Germany.,Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| |
Collapse
|
16
|
Claussen CS, Moir G, Bechara FG, Orlando A, Matteucci P, Mowatt D, Clover AJP, Mascherini M, Gehl J, Muir T, Sersa G, Groselj A, Odili J, Giorgione R, Campana LG, Bertino G, Curatolo P, Banerjee S, Kis E, Quaglino P, Pritchard-Jones R, De Terlizzi F, Grischke EM, Kunte C. Prospective cohort study by InspECT on safety and efficacy of electrochemotherapy for cutaneous tumors and metastases depending on ulceration. J Dtsch Dermatol Ges 2022; 20:470-481. [PMID: 35384261 DOI: 10.1111/ddg.14699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electrochemotherapy (ECT) is an effective local treatment for cutaneous tumors. The aim of this study was to compare the effectiveness of ECT in ulcerated vs. non-ulcerated tumors and investigate the effect on tumor-associated symptoms. METHODS Twenty cancer centers in the International Network for Sharing Practices on Electrochemotherapy (InspECT) prospectively collected data. ECT was performed following ESOPE protocol. Response was evaluated by lesion size development. Pain, symptoms, performance status (ECOG-Index) and health status (EQ-5D questionnaire) were evaluated. RESULTS 716 patients with ulcerated (n = 302) and non-ulcerated (n = 414) cutaneous tumors and metastases were included (minimum follow-up of 45 days). Non-ulcerated lesions responded to ECT better than ulcerated lesions (complete response 65 % vs. 51 %, p = 0.0061). Only 38 % (115/302) with ulcerated lesions before ECT presented with ulcerated lesions at final follow-up. Patients with ulcerated lesions reported higher pain and more severe symptoms compared to non-ulcerated lesions, which significantly and continuously improved following ECT. In non-ulcerated lesions however, pain spiked during the treatment. No serious adverse events were reported. CONCLUSIONS ECT is a safe and effective local treatment for cutaneous tumors. While ECT improves symptoms especially in patients with ulcerated lesions, data suggest the implementation of a perioperative pain management in non-ulcerated lesions during ECT.
Collapse
Affiliation(s)
- Carla Sophie Claussen
- Department of Dermatosurgery and Dermatology, Artemed Clinic of Munich, Munich, Germany
| | - Graeme Moir
- The Royal London Hospital & QMUL, Barts Health NHS Trust, Department of Cutaneous Medicine & Surgery, London, United Kingdom
| | - Falk G Bechara
- Department of Dermatologic Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Antonio Orlando
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Paolo Matteucci
- Department of Plastic surgery, Castle Hill Hospital, Cottingham, United Kingdom
| | - David Mowatt
- Plastic Surgery Department, The Christie Hospital NHS Foundation trust, Manchester, United Kingdom
| | - Anthony James P Clover
- Department of Plastic Surgery, Cork University Hospital, Cork, Ireland.,Cancer Research@UCC, Western Gateway Building, University College Cork, Cork, Ireland
| | - Matteo Mascherini
- Clinica Chirurgica 1 - Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), 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
| | - Tobian Muir
- Plastic Surgery Department, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Joy Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Luca Giovanni Campana
- Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.,Department of Surgery, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Pietro Curatolo
- Department of Dermatology and Plastic Surgery, Dermatologic Clinic, University of Roma "La Sapienza", Roma, Italy
| | - Shramana Banerjee
- Division of Surgery and interventional Science, University College London, London, United Kingdom
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | | | - Eva-Maria Grischke
- Department of Gynecology, University Hospital of Tübingen, Tübingen, Germany
| | - Christian Kunte
- Department of Dermatosurgery and Dermatology, Artemed Clinic of Munich, Munich, Germany.,Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| |
Collapse
|
17
|
Combination of Pembrolizumab with Electrochemotherapy in Cutaneous Metastases from Melanoma: A Comparative Retrospective Study from the InspECT and Slovenian Cancer Registry. Cancers (Basel) 2021; 13:cancers13174289. [PMID: 34503099 PMCID: PMC8428335 DOI: 10.3390/cancers13174289] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/14/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Electrochemotherapy (ECT) combines a cytotoxic agent with locally applied electric pulses to enhance its antitumor effect. Over the last 15 years, ECT has been safely applied to patients with skin metastases in combination with other oncologic treatments and, more recently, with systemic immunotherapy. In this study, we aimed to investigate the effectiveness of ECT in combination with pembrolizumab. We compared patient outcomes after the following treatments: (a) pembrolizumab, (b) pembrolizumab and ECT, and (c) ECT alone. The combined application of pembrolizumab and ECT was safe and more efficacious in preventing further growth of cutaneous metastases than pembrolizumab alone. The patients treated with pembrolizumab and ECT experienced lower disease progression rates and longer survival than those who received pembrolizumab. ECT may boost the effect of pembrolizumab by acting as an in situ vaccination against cancer cells. Further studies are required to confirm these findings. Abstract Electrochemotherapy (ECT) is an effective locoregional therapy for cutaneous melanoma metastases and has been safely combined with immune checkpoint inhibitors in preliminary experiences. Since ECT is known to induce immunogenic cell death, its combination with immune checkpoint inhibitors might be beneficial. In this study, we aimed to investigate the effectiveness of ECT on cutaneous melanoma metastases in combination with pembrolizumab. We undertook a retrospective matched cohort analysis of stage IIIC–IV melanoma patients, included in the International Network for sharing practices of ECT (InspECT) and the Slovenian Cancer Registry. We compared the outcome of patients who received the following treatments: (a) pembrolizumab alone, (b) pembrolizumab plus ECT, and (c) ECT. The groups were matched for age, sex, performance status, and size of skin metastases. The local objective response rate (ORR) was higher in the pembrolizumab-ECT group than in the pembrolizumab group (78% and 39%, p < 0.001). The 1 year local progression-free survival (LPFS) rates were 86% and 51% (p < 0.001), and the 1 year systemic PFS rates were 64% and 39%, respectively (p = 0.034). The 1 year overall survival (OS) rates were 88% and 64%, respectively (p = 0.006). Our results suggest that skin-directed therapy with ECT improves superficial tumor control in melanoma patients treated with pembrolizumab. Interestingly, we observed longer PFS and OS in the pembrolizumab-ECT group than in the pembrolizumab group. These findings warrant prospective confirmation.
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Campanacci L, Bianchi G, Cevolani L, Errani C, Ciani G, Facchini G, Spinnato P, Tognù A, Massari L, Cornelis FH, Mosconi M, Screpis D, Benazzo F, Rossi B, Bonicoli E, Fazioli F, Nicolosi M, Boffano M, Piana R, De Terlizzi F, Cadossi M, Donati DM. Operating procedures for electrochemotherapy in bone metastases: Results from a multicenter prospective study on 102 patients. Eur J Surg Oncol 2021; 47:2609-2617. [PMID: 34083080 DOI: 10.1016/j.ejso.2021.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Bone metastases are frequent in patients with cancer. Electrochemotherapy (ECT) is a minimally invasive treatment. Preclinical and clinical studies supported the use of ECT in patients with metastatic bone disease (MBD). The purposes of this multicentre study are to confirm the safety and efficacy of ECT, and to identify appropriate operating procedures in different MBD conditions. MATERIALS AND METHODS 102 patients were treated in 11 Centres and recorded in the REINBONE registry (a shared database protected by security passwords): clinical and radiological information, ECT session, adverse events, response, quality of life indicators and duration of follow-up were registered. RESULTS 105 ECT sessions were performed (one ECT session in 99 patients, two ECT sessions in 3 patients). 24 patients (23.5%) received a programmed intramedullary nail after ECT, during the same surgical procedure. Mean follow-up was 5.9 ± 5.1 months (range 1.5-52). The response to treatment by RECIST criteria was 40.4% objective responses, 50.6% stable disease and 9% progressive disease. According to PERCIST criteria the response was: 31.4% OR; 51.7% SD, 16.9% PD with no significant differences between the 2 criteria. Diagnosis of breast cancer and ECOG values 0-1 were significantly associated to objective response. A significant decrease in pain intensity and significant better quality of life was observed after ECT session at follow-up. CONCLUSION The results are encouraging on pain and tumour local control. ECT proved to be an effective and safe treatment for MBD and it should be considered as an alternative treatment as well as in combination with radiation therapy.
Collapse
Affiliation(s)
- Laura Campanacci
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Giuseppe Bianchi
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Luca Cevolani
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Costantino Errani
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Giovanni Ciani
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Giancarlo Facchini
- Department of Radiology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Paolo Spinnato
- Department of Radiology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Andrea Tognù
- Department of Anaestesiology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Leo Massari
- Dipartimento di Neuroscienze e Riabilitazione, Università di Ferrara, U.O. di Clinica Ortopedica e Traumatologica, Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Italy.
| | - Francois H Cornelis
- Sorbonne Université, Department of Interventional Radiology, Hôpital Tenon 4 rue de la Chine, 75020, Paris, France.
| | - Mario Mosconi
- Fondazione IRCCS Policlinico San Matteo Pavia, UOC Ortopedia e Traumatologia, Italy.
| | - Daniele Screpis
- U.O. Ortopedia e Traumatologia - Ospedale Sacrocuore Don Calabria, Via don A. Sempreboni 5, Negrar di Valpolicella, 37024, Vr, Italy.
| | - Francesco Benazzo
- Sezione Universitaria di Chirurgia Protesica Ad Indirizzo Robotico, Unità di Traumatologia dello Sport Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
| | - Barbara Rossi
- UOC Oncologic Orthopaedics, IRCCS Regina Elena National Cancer Institute - Rome, Italy.
| | - Enrico Bonicoli
- U.O. Ortopedia e Traumatologia 1(a) Universitaria, Cisanello-Pisa, Italy.
| | - Flavio Fazioli
- Division of Oncological Orthopedics National Cancer Institute G. Pascale, Naples, Italy.
| | | | - Michele Boffano
- SC Chirurgia Oncologica Ortopedica, AOU Città della Salute e della Scienza di Torino, Presidio CTO - Via Zuretti 29, 10126, Torino, Italy.
| | - Raimondo Piana
- SC Chirurgia Oncologica Ortopedica, AOU Città della Salute e della Scienza di Torino, Presidio CTO - Via Zuretti 29, 10126, Torino, Italy.
| | | | - Matteo Cadossi
- IGEA Clinical Biophysics, Via Parmenide 10/A, 41012, Carpi, MO, Italy.
| | - Davide Maria Donati
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| |
Collapse
|
20
|
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.
Collapse
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.)
| |
Collapse
|
21
|
Iezzi M, Quaglino E, Amici A, Lollini PL, Forni G, Cavallo F. DNA vaccination against oncoantigens: A promise. Oncoimmunology 2021; 1:316-325. [PMID: 22737607 PMCID: PMC3382874 DOI: 10.4161/onci.19127] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The emerging evidence that DNA vaccines elicit a protective immune response in rodents, dogs and cancer patients, coupled with the US Food and Drug Administration (FDA) approval of an initial DNA vaccine to treat canine tumors is beginning to close the gap between the optimistic experimental data and their difficult application in a clinical setting. Here we review a series of conceptual and biotechnological advances that are working together to make DNA vaccines targeting molecules that play important roles during cancer progression (oncoantigens) a promise with near-term clinical impact.
Collapse
Affiliation(s)
- Manuela Iezzi
- Aging Research Centre; G. d'Annunzio University; Chieti, Italy
| | | | | | | | | | | |
Collapse
|
22
|
Electrochemotherapy in the treatment of cutaneous malignancy: Outcomes and subgroup analysis from the cumulative results from the pan-European International Network for Sharing Practice in Electrochemotherapy database for 2482 lesions in 987 patients (2008-2019). Eur J Cancer 2020; 138:30-40. [PMID: 32836172 DOI: 10.1016/j.ejca.2020.06.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/01/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Electrochemotherapy (ECT) is a treatment for both primary and secondary cutaneous tumours. The international Network for sharing practices on ECT group investigates treatment outcomes after ECT using a common database with defined parameters. METHODS Twenty-eight centres across Europe prospectively uploaded data over an 11-year period. Response rates were investigated in relation to primary diagnosis, tumour size, choice of electrode type, route of bleomycin administration, electrical parameters recorded and previous irradiation in the treated field. RESULTS Nine hundred eighty-seven patients, with 2482 tumour lesions were included in analysis. The overall response (OR) rate was 85% (complete response [CR]: 70%, partial response rate: 15%, stable disease: 11%, and progressive disease: 2%). For different histologies, OR and CR rates for metastases of malignant melanoma were 82% and 64%, basal cell carcinoma were 96% and 85%, breast cancer metastases were 77% and 62%, squamous cell carcinoma were 80% and 63% as well as Kaposi's sarcoma were 98% and 91%, respectively. Variance was demonstrated across histotypes (p < 0.0001) and in accordance with size of lesion treated (dichotomised at diameter of 3 cm (p < 0.0001). Hexagonal electrodes were generally used for larger tumours, but for tumours up to 3 cm, linear array electrodes provided better tumour control than hexagonal electrodes (80%:74%, p < 0.003). For tumours more than 2 cm, intravenous administration was superior to intratumoural (IT) administration (p < 0.05). Current recorded varied across tumour histologies and size but did not influence response rate. In previously irradiated areas, responses were selectively lower for IT administration. CONCLUSIONS These cumulative data endorse efficiency of ECT across a broad range of histotypes. Analysis of 2482 lesions details subgroup analysis on treatment response informing future treatment choices.
Collapse
|
23
|
Reversible Electrochemotherapy (ECT) as a Treatment Option for Local RCC Recurrence in Solitary Kidney. Cardiovasc Intervent Radiol 2020; 43:1091-1094. [PMID: 32415331 DOI: 10.1007/s00270-020-02498-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
A 61-year-old female underwent a right radical nephrectomy and a left nephron sparing surgery in 2014 due to renal cell carcinoma. A renal cell carcinoma local recurrence, 28 mm in size, centrally located in the left kidney was treated using cryoablation in 2016. In November 2018, computed tomography (CT) scan showed three nodules (maximum size 15 × 11 mm) in the left kidney, and CT-guided needle biopsy was performed. For multifocal recurrence and the anatomical site of these three nodules, a simultaneous reversible electrochemotherapy treatment was performed in April 2019. At 6-month CT control, no evidence of residual disease was found. Electrochemotherapy could be used to treat locoregional renal cell carcinoma recurrence when other ablative techniques are not suitable. LEVEL OF EVIDENCE: Level 4, Case Report.
Collapse
|
24
|
Falk Hansen H, Bourke M, Stigaard T, Clover J, Buckley M, O’Riordain M, Winter DC, Hjorth Johannesen H, Hansen RH, Heebøll H, Forde P, Jakobsen HL, Larsen O, Rosenberg J, Soden D, Gehl J. Electrochemotherapy for colorectal cancer using endoscopic electroporation: a phase 1 clinical study. Endosc Int Open 2020; 8:E124-E132. [PMID: 32010744 PMCID: PMC6976320 DOI: 10.1055/a-1027-6735] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/16/2019] [Indexed: 12/21/2022] Open
Abstract
Background and study aims Electrochemotherapy is an anticancer treatment that uses electric pulses to facilitate uptake of chemotherapeutic drugs in tumor cells and has proven to have a high local cytotoxic effect with minimal adverse events. Electrochemotherapy has mostly been used in treatment of cutaneous metastases but development of a new endoscopic electrode device has made treatment of colorectal tumors possible. This first-in-man multicenter phase I study investigated safety and efficacy of electrochemotherapy using endoscopic electroporation in patients with colorectal tumors. Patients and methods Seven patients with colorectal tumors who were deemed ineligible for or had declined standard treatment were included. They were treated with bleomycin either intratumorally or intravenously and the electric pulses were delivered through the endoscopic electrode device. Safety and efficacy were assessed clinically and by scans immediately after treatment and adverse events were reported. Response was evaluated up to 6 months after treatment by scans (magnetic resonance imaging or computed tomography) and endoscopic examinations. Results Seven patients aged 62 to 88 years with multiple comorbidities were included and had one or two treatments each. Post-treatment scans showed tumor responses in the treated areas and no damage to surrounding tissues. Only a few grade one adverse events were reported. Three patients had preoperative rectal bleeding, of which two reported cessation of bleeding and one reported decreased bleeding. Conclusion This first-in-man study shows that electrochemotherapy for colorectal tumors using the endoscopic electrode device can induce local tumor response and is safe also for fragile elderly patients with comorbidities.
Collapse
Affiliation(s)
- Hanne Falk Hansen
- Center for experimental drug and gene electrotransfer (C*EDGE), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Michael Bourke
- Cork Cancer Research Centre, University College Cork, Ireland
| | - Trine Stigaard
- Gastro Unit, Department of Surgical Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - James Clover
- Cork Cancer Research Centre, University College Cork, Ireland
| | - Martin Buckley
- Gastroenterology Department, Mercy University Hospital, Cork, Ireland
| | | | - Des C. Winter
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland
| | - Helle Hjorth Johannesen
- Department of Radiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Rasmus Hvass Hansen
- Department of Radiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Hanne Heebøll
- Department of Radiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Patrick Forde
- Cork Cancer Research Centre, University College Cork, Ireland
| | - Henrik Loft Jakobsen
- Gastro Unit, Department of Surgical Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Ole Larsen
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen. Denmark
| | - Jacob Rosenberg
- Gastro Unit, Department of Surgical Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Declan Soden
- Cork Cancer Research Centre, University College Cork, Ireland
| | - Julie Gehl
- Center for experimental drug and gene electrotransfer (C*EDGE), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark,Center for Experimental Drug and Gene Electrotransfer (C*EDGE), 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,Corresponding author Prof. Julie Gehl Center for Experimental Drug and Gene Electrotransfer (C*EDGE)Department of Clinical Oncology and Palliative CareZealand University HospitalSygehusvej 104000 RoskildeDenmark+46326994
| |
Collapse
|
25
|
Electrochemotherapy for the palliative management of cutaneous metastases: A systematic review and meta-analysis. Eur J Surg Oncol 2019; 45:2257-2267. [DOI: 10.1016/j.ejso.2019.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022] Open
|
26
|
Wolff CM, Steuer A, Stoffels I, von Woedtke T, Weltmann KD, Bekeschus S, Kolb JF. Combination of cold plasma and pulsed electric fields – A rationale for cancer patients in palliative care. CLINICAL PLASMA MEDICINE 2019. [DOI: 10.1016/j.cpme.2020.100096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
27
|
Read RL, Thompson JF. Managing in-transit melanoma metastases in the new era of effective systemic therapies for melanoma. Expert Rev Clin Pharmacol 2019; 12:1107-1119. [DOI: 10.1080/17512433.2019.1689121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Rebecca L Read
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Department of General Surgery, Calvary Health Care, Canberra, Australia
- School of Medicine, Australian National University, Canberra, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
28
|
Campana LG, Miklavčič D, Bertino G, Marconato R, Valpione S, Imarisio I, Dieci MV, Granziera E, Cemazar M, Alaibac M, Sersa G. Electrochemotherapy of superficial tumors - Current status:: Basic principles, operating procedures, shared indications, and emerging applications. Semin Oncol 2019; 46:173-191. [PMID: 31122761 DOI: 10.1053/j.seminoncol.2019.04.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 12/18/2022]
Abstract
Treatment of superficial tumors with electrochemotherapy (ECT) has shown a steep rise over the past decade and indications range from skin cancers to locally advanced or metastatic neoplasms. Based on reversible electroporation, which is a physical method to achieve transient tumor cell membrane permeabilization by means of short electric pulses, ECT increases cellular uptake of bleomycin and cisplatin and their cytotoxicity by 8,000- and 80-fold, respectively. Standard operating procedures were established in 2006 and updated in 2018. Ease of administration, patient tolerability, efficacy across histotypes, and repeatability are peculiar advantages, which make standard ECT (ie, ECT using fixed-geometry electrodes) a reliable option for controlling superficial tumor growth locally and preventing their morbidity. Consolidated indications include superficial metastatic melanoma, breast cancer, head and neck skin tumors, nonmelanoma skin cancers, and Kaposi sarcoma. In well-selected patients with oropharyngeal cancers, ECT ensures appreciable symptom control. Emerging applications include skin metastases from visceral or hematological malignancies, vulvar cancer, and some noncancerous skin lesions (keloids and capillary vascular malformations). Repeatability and integration with other oncologic therapies allow for consolidation of response and sustained tumor control. In this review, we present the basic principles of ECT, recently updated operating procedures, anesthesiological management, and provide a synthesis of the efficacy of standard ECT across histotypes.
Collapse
Affiliation(s)
- Luca G Campana
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy; Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
| | - Damijan Miklavčič
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | | | - Ilaria Imarisio
- Medical Oncology Unit, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Maria Vittoria Dieci
- Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; Medical Oncology-2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Elisa Granziera
- Anesthesiology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Mauro Alaibac
- Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
29
|
Racz JM, Block MS, Baum CL, Jakub JW. Management of local or regional non‐nodal disease. J Surg Oncol 2018; 119:187-199. [DOI: 10.1002/jso.25330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022]
|
30
|
Frandsen SK, Gehl J. A Review on Differences in Effects on Normal and Malignant Cells and Tissues to Electroporation-Based Therapies: A Focus on Calcium Electroporation. Technol Cancer Res Treat 2018; 17:1533033818788077. [PMID: 30012047 PMCID: PMC6050800 DOI: 10.1177/1533033818788077] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Calcium electroporation is a potential novel anticancer treatment, where high
concentrations of calcium are introduced into the cell cytosol by electroporation. This is
a method where short, high-voltage pulses induce a transient permeabilization of the cell
membrane and thereby allow influx and efflux of ions and molecules. Electroporation is
used in combination with chemotherapeutic drugs (electrochemotherapy) as a standard
treatment for cutaneous metastases, and electroporation using a higher electric field and
number of pulses (irreversible electroporation) is increasingly being used as an
anticancer treatment. In this review, calcium electroporation is described with emphasis
on the investigations of differences in the effect on normal and malignant cells and
tissues in vitro and in vivo. Calcium electroporation
has been shown to induce cell death in vitro and tumor necrosis
in vivo with a difference in sensitivity between different tumor types.
Normal cells treated in vitro are significantly less affected than cancer
cells, and a similar trend is shown in vivo where muscle and skin tissue
surrounding a treated tumor as well as muscle and skin directly treated with calcium
electroporation were less affected than tumors. The mechanism behind this difference in
sensitivity is not fully understood but might be affected by differences in electric
impedance, membrane repair, and expression of plasma membrane calcium ATPases in normal
and malignant cells. The research on calcium electroporation shows a potential novel
anticancer treatment with significant effect on cancer cells and tissues while normal
cells and tissues are clearly less affected.
Collapse
Affiliation(s)
- Stine K Frandsen
- 1 Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Julie Gehl
- 1 Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark.,2 Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
31
|
Rezaee Z, Yadollahpour A, Bayati V. Single Intense Microsecond Electric Pulse Induces Radiosensitization to Ionizing Radiation: Effects of Time Intervals Between Electric Pulse and Ionizing Irradiation. Front Oncol 2018; 8:418. [PMID: 30319980 PMCID: PMC6171481 DOI: 10.3389/fonc.2018.00418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022] Open
Abstract
Background and Objective: Recent studies have shown the potential of electroporation (EP) as a physical radiosensitizer for ionizing radiation (IR). The amount of sensitizing effect depends on some factors the most important of them is the time interval between the EP and IR. This experimental in vitro study aims to investigate the radiosensitizing effect of EP exposure prior to IR and also evaluate the effects of EP-IR time intervals on the amount of radiosensitizing effects. Methods: Chinese hamster ovary (CHO) cell lines were cultured in vitro. The cells were divided into 10 groups including one untreated or control group, IR, and EP treatment alone groups, and seven combined EP-IR groups with 10, 20, 30, 40, 50, 60, and 70 min intervals. The dose enhancement factors (DEFs) for 6 MV X-rays IR were comparatively investigated between the groups using MTT assay. Results: The EP significantly induced radiosensitizing effect and its amount depends on the time intervals. The viability rate of the cells in the combined EP-IR treatment groups for intervals of 10, 20, 30, 40, and 50 min was significantly lower than the IR alone group. The highest DEF (1.18) was observed 10 min time interval between EP and IR. Conclusion: The radiosensitizing effects of EP persist long enough, 10–50 min, which allows safe application of EP as a radiosensitizer before IR in clinical setting.
Collapse
Affiliation(s)
- Zohre Rezaee
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Yadollahpour
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Vahid Bayati
- Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
32
|
Long term effectiveness of electrochemotherapy for the treatment of lower lip squamous cell carcinoma. J Craniomaxillofac Surg 2018; 46:1968-1974. [PMID: 30244963 DOI: 10.1016/j.jcms.2018.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/28/2018] [Accepted: 08/23/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Electrochemotherapy (ECT) is a therapeutic approach based on the local application of electrical pulses that permeabilize cell membranes to enhance the uptake of low-permeant chemotherapeutic agents, thus increasing their cytotoxic effects. MATERIALS AND METHODS Twenty-one patients with SCC of the lower lip were treated according to the European Standard Operating Procedures of Electrochemotherapy. Bleomycin (15,000 IU/m2 body surface area) was administered intravenously over a 1-min period. Eight electrical pulses (amplitude, 1000 V/cm; duration, 100 μs) were generated and delivered at a repetition frequency of 5 kHz. Changes in tumor volume were used to assess treatment response. RESULTS Objective response (OR), complete response (CR), and partial response (PR) rates of 100%, 71.4%, and 28.6% respectively were demonstrated following a single session of ECT. ECT was well tolerated, and no adverse events occurred. CONCLUSIONS Intravenous bleomycin-based ECT is a safe and effective therapy for SCC of the lower lip. ECT improves the quality-of-life of patients by preserving the function and the aesthetic appearance of the affected area. ECT provides a therapeutic option for elderly and frail patients who, due to their state of health, are not suitable for, or refuse surgical interventions.
Collapse
|
33
|
Electrochemotherapy in the treatment of melanoma. Contemp Oncol (Pozn) 2018; 22:8-13. [PMID: 29692657 PMCID: PMC5909724 DOI: 10.5114/wo.2018.74387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/16/2017] [Indexed: 12/21/2022] Open
Abstract
Electrochemotherapy is a new therapeutic option for patients with locally spread melanoma. It is based on the phenomenon of reversible electroporation, i.e. a transient increase in permeability of cell membranes under the influence of an appropriately modulated electric field. This allows multiplication of toxicity of a cytostatic agent entering the tumour cell. It is highly effective, especially in the palliative treatment of cancers located in the integument of the human body (skin and subcutaneous tissue). Available literature provides a mandate both for the application of this method in the aforementioned cases as well as for further work on its development. This paper focuses on reviewing the literature concerning the use of electrochemotherapy in the treatment of melanoma.
Collapse
|
34
|
Al-Hadithy N, Dehnel A, George A, Kisiel R, Lunt C, Stone C. Patient reported outcomes in prospective cohort study of Electrochemotherapy. Int J Surg 2018; 52:110-119. [DOI: 10.1016/j.ijsu.2018.02.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/06/2018] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
|
35
|
Falk H, Matthiessen L, Wooler G, Gehl J. Calcium electroporation for treatment of cutaneous metastases; a randomized double-blinded phase II study, comparing the effect of calcium electroporation with electrochemotherapy. Acta Oncol 2018; 57:311-319. [PMID: 28816072 DOI: 10.1080/0284186x.2017.1355109] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Calcium electroporation is a novel anticancer treatment, which utilizes high voltage pulses to permeabilize cell membranes and expose the cell to supraphysiological doses of calcium. Preclinical studies on calcium electroporation have shown strikingly high tumor response with cell necrosis. Calcium electroporation builds on the treatment electrochemotherapy, where chemotherapeutic drugs, mostly bleomycin, are internalized by electroporation. This double-blinded randomized study compared calcium electroporation to electrochemotherapy in terms of objective response measured 6 months after treatment. METHODS Seven patients with a total of 47 cutaneous metastases from breast cancer and malignant melanoma were included in the protocol. A total of 37 metastases were randomized and evaluated for response, another 10 metastases were used for biopsy. This was a non-inferiority trial and metastases were randomized individually in each patient to either intratumoral calcium or bleomycin followed by application of electric pulses to tumor site. All metastases were treated once, and after 6-months of follow-up, the randomization code was revealed. RESULTS Objective response of calcium electroporation was 72% (13/18) with complete response in 66% (12/18). For electrochemotherapy, objective response was 84% (16/19) with complete response in 68% (13/19). There was no statistically significant difference between the two treatments (p = 0.5). After 1 year, only three out of 25 metastases had relapsed. Ulceration, itching and exudation were reported slightly more frequently in metastases treated with bleomycin, and hyperpigmentation was only seen in metastases treated with bleomycin. CONCLUSION This study shows that calcium electroporation is feasible and effective in patients with cutaneous metastases.
Collapse
Affiliation(s)
- H. Falk
- Center for Experimental Drug and Gene Electrotransfer CEDGE, Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - L.W. Matthiessen
- Center for Experimental Drug and Gene Electrotransfer CEDGE, Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - G. Wooler
- Department of Pathology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - J. Gehl
- Center for Experimental Drug and Gene Electrotransfer CEDGE, Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| |
Collapse
|
36
|
Macripò G, Caliendo V, Grassi M, Lista P, Ribero S, Giacone E, Milanese E, Ciuffreda L. Squamous Cell Carcinoma of the Umbilicus: Management of an Unusual Localization. TUMORI JOURNAL 2018; 97:236-8. [DOI: 10.1177/030089161109700219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe the case of a squamous cell carcinoma spreading to the skin and regional lymph nodes from the umbilicus. Bilateral inguinal lymphadenectomy and a session of electrochemotherapy with bleomycin 15 mg/m2 were performed. However, because of the development of new cutaneous nodules in the abdominopelvic region, we performed targeted palliative therapy with erlotinib 150 mg/day. Targeted adjuvant therapy was preferred to the use of a major cytotoxic agent because of the high risk of superinfection and heart failure. Erlotinib produced a partial clinical response with reduction of the number and size of the skin nodules. CT scan performed after 60 days of treatment did not show any new lesions. To our knowledge, this is the first report of an umbilical metastatic squamous cell carcinoma treated with modern targeted therapy. This therapeutic strategy can be considered a valid palliative option in the management of metastatic cutaneous nodules of this rare primary site.
Collapse
Affiliation(s)
- Giuseppe Macripò
- Department of Oncology and Hematology, Dermatologic Surgery, AOU San Giovanni Battista-Molinette, Ospedale San Lazzaro, Turin
| | - Virginia Caliendo
- Department of Oncology and Hematology, Dermatologic Surgery, AOU San Giovanni Battista-Molinette, Ospedale San Lazzaro, Turin
| | - Marcella Grassi
- Department of Oncology and Hematology, Dermatologic Surgery, AOU San Giovanni Battista-Molinette, Ospedale San Lazzaro, Turin
| | - Patrizia Lista
- Department of Oncology and Hematology, Section of Medical Oncology, Centro Oncologico Subalpino (COES), AOU San Giovanni Battista-Molinette, Turin, Italy
| | - Simone Ribero
- Department of Oncology and Hematology, Dermatologic Surgery, AOU San Giovanni Battista-Molinette, Ospedale San Lazzaro, Turin
| | - Elena Giacone
- Department of Oncology and Hematology, Dermatologic Surgery, AOU San Giovanni Battista-Molinette, Ospedale San Lazzaro, Turin
| | - Enrica Milanese
- Department of Oncology and Hematology, Section of Medical Oncology, Centro Oncologico Subalpino (COES), AOU San Giovanni Battista-Molinette, Turin, Italy
| | - Libero Ciuffreda
- Department of Oncology and Hematology, Section of Medical Oncology, Centro Oncologico Subalpino (COES), AOU San Giovanni Battista-Molinette, Turin, Italy
| |
Collapse
|
37
|
Probst U, Fuhrmann I, Beyer L, Wiggermann P. Electrochemotherapy as a New Modality in Interventional Oncology: A Review. Technol Cancer Res Treat 2018; 17:1533033818785329. [PMID: 29986632 PMCID: PMC6048674 DOI: 10.1177/1533033818785329] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/01/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022] Open
Abstract
Electroporation is a well-known phenomenon that occurs at the cell membrane when cells are exposed to high-intensity electric pulses. Depending on electric pulse amplitude and number of pulses, applied electroporation can be reversible with membrane permeability recovery or irreversible. Reversible electroporation is used to introduce drugs or genetic material into the cell without affecting cell viability. Electrochemotherapy refers to a combined treatment: electroporation and drug injection to enhance its cytotoxic effect up to 1000-fold for bleomycin. Since several years, electrochemotherapy is gaining popularity as minimally invasive oncologic treatment. The adoption of electrochemotherapy procedure in interventional oncology poses several unsolved questions, since suitable tumor histology and size as well as therapeutic efficacy still needs to be deepen. Electrochemotherapy is usually applied in palliative settings for the treatment of patients with unresectable tumors to relieve pain and ameliorate quality of life. In most cases, it is used in the treatment of advanced stages of neoplasia when radical surgical treatment is not possible (eg, due to lesion location, size, and/or number). Further, electrochemotherapy allows treating tumor nodules in the proximity of important structures like vessels and nerves as the treatment does not involve tissue heating. Overall, the safety profile of electrochemotherapy is favorable. Most of the observed adverse events are local and transient, moderate local pain, erythema, edema, and muscle contractions during electroporation. The aim of this article is to review the recent published clinical experiences of electrochemotherapy use in deep-seated tumors with particular focus on liver cases. The principle of electrochemotherapy as well as the application to cutaneous metastases is briefly described. A short insight in the treatment of bone metastases, unresectable pancreas cancer, and soft tissue sarcoma will be given. Preclinical and clinical studies on treatment efficacy with electrochemotherapy of hepatic lesions and safety of the procedure adopted are discussed.
Collapse
Affiliation(s)
- Ute Probst
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
| | - Irene Fuhrmann
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
| | - Lukas Beyer
- Städtisches Klinikum Braunschweig, Institut für Röntgendiagnostik und
Nuklearmedizin, Braunschweig, Germany
| | - Philipp Wiggermann
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
| |
Collapse
|
38
|
Plaschke CC, Bertino G, McCaul JA, Grau JJ, de Bree R, Sersa G, Occhini A, Groselj A, Langdon C, Heuveling DA, Cemazar M, Strojan P, Leemans CR, Benazzo M, De Terlizzi F, Wessel I, Gehl J. European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project: Results from the treatment of mucosal cancers. Eur J Cancer 2017; 87:172-181. [DOI: 10.1016/j.ejca.2017.10.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/04/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022]
|
39
|
Bianchi G, Campanacci L, Ronchetti M, Donati D. Electrochemotherapy in the Treatment of Bone Metastases: A Phase II Trial. World J Surg 2017; 40:3088-3094. [PMID: 27443372 PMCID: PMC5104781 DOI: 10.1007/s00268-016-3627-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction Bone metastatic disease is a major cause of pain and decreased quality of life in patients with cancer. In addition to systemic therapy and pain control with narcotic analgesics, standard local treatments include palliation with radiation therapy and surgery. However, 20–30 % of patients do not respond to conventional treatments, increasing the interest in alternative therapies. We present the results of a new minimally invasive technique in the treatment of bone metastases. Methods Twenty-nine patients affected by painful bone metastases were treated with electrochemotherapy (ECT) from July 2009 to July 2011; the mean age was 60 years (range 37–87); 21 patients received a previous ineffective local treatment; the appendicular skeleton was affected in 15 patients while in 14 patients other sites were involved. ECT was performed using the Cliniporator Vitae under fluoroscopy or CT guidance depending on the site of the lesion. Clinical response was assessed using VAS scale and objective tumour response was evaluated according to the MD Anderson criteria for bone metastases. Results All patients well tolerated the procedure and no intraoperative or postoperative complications were observed. At a mean follow-up of 7 months, 24 patients were available for evaluation. 84 % of the patients (20 out of 24) referred improvement of pain ≥50 % with reduction of narcotics consumption. Radiographic evaluation after 3 months in 20 evaluable patients, showed “partial response” in 1 patient, “stable disease” in 17 and “progression” in two cases. Discussion Results reported in this study demonstrated ECT to be safe and feasible in the treatment of painful bone metastases even when other previous treatments were ineffective. Pain and disease progression control was achieved in the majority of the patients with consequent improvement of quality of life. Conclusion ECT should be considered a new feasible tool in the treatment of bone metastases in place or in combination with standard treatments; further developments are required to extend the use of this technique to spine metastases.
Collapse
Affiliation(s)
- Giuseppe Bianchi
- Clinica Ortoepdica III, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Laura Campanacci
- Clinica Ortoepdica III, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mattia Ronchetti
- Oncology Clinical, Research & Development, IGEA S.p.A., via Parmenide 10/a, 41012, Carpi, Modena, Italy
| | - Davide Donati
- Clinica Ortoepdica III, Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
40
|
Rubio-Rodríguez D, De Diego Blanco S, Pérez M, Rubio-Terrés C. Cost-Effectiveness of Drug Treatments for Advanced Melanoma: A Systematic Literature Review. PHARMACOECONOMICS 2017; 35:879-893. [PMID: 28551858 DOI: 10.1007/s40273-017-0517-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Until recently, advanced melanoma (unresectable and metastatic) has had a poor prognosis and has been treated with chemotherapy. The introduction of new treatments (BRAF and MEK inhibitors and immunotherapy) has improved overall survival and progression-free survival of some patients. OBJECTIVE The objective of this study was to review the published evidence on the cost-effectiveness of pharmacological treatments for advanced melanoma. METHODS A systematic literature search was conducted, without date or language restrictions, in PubMed, EMBASE, Scopus, the Cochrane Library, the UK National Institute for Health and Care Excellence databases and the Health Technology Assessment journal. Internet searches were also made to identify possible grey literature. Main study characteristics, methods and outcomes were extracted and critically assessed. The quality of health economic studies was assessed by the Quality Assessment of Economic Evaluation in Health Care checklist. RESULTS The search identified nine full-text pharmacoeconomic analyses of advanced melanoma treatments. According to the economic analyses published in the articles, the new treatments have been shown to be more effective (with more life-years and quality-adjusted life-years) than chemotherapy, although generally the cost per quality-adjusted life-year gained was above the commonly accepted threshold. Because of the variability of the available analyses comparing the new treatments, we cannot determine which treatment is the most cost-effective. CONCLUSIONS From the available data, it cannot be concluded that the new drugs (BRAF and MEK inhibitors and immunotherapy) are cost effective compared with chemotherapy or which is the most cost-effective new treatment.
Collapse
Affiliation(s)
| | | | - Maite Pérez
- Medical Department, AstraZeneca Farmacéutica Spain, Barcelona, Spain
| | | |
Collapse
|
41
|
Falk H, Lambaa S, Johannesen HH, Wooler G, Venzo A, Gehl J. Electrochemotherapy and calcium electroporation inducing a systemic immune response with local and distant remission of tumors in a patient with malignant melanoma - a case report. Acta Oncol 2017; 56:1126-1131. [PMID: 28562201 DOI: 10.1080/0284186x.2017.1290274] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Hanne Falk
- a Department of Oncology , Herlev and Gentofte Hospital, Center for Experimental Drug and Gene Electrotransfer (CEDGE), University of Copenhagen , Herlev , Denmark
| | - Susanne Lambaa
- b Department of Plastic Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Helle Hjorth Johannesen
- c Department of Radiology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Gitte Wooler
- d Department of Pathology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Alessandro Venzo
- e Department of Plastic Surgery, Rigshospitalet , University of Copenhagen , Copenhagen , Denmark
| | - Julie Gehl
- a Department of Oncology , Herlev and Gentofte Hospital, Center for Experimental Drug and Gene Electrotransfer (CEDGE), University of Copenhagen , Herlev , Denmark
| |
Collapse
|
42
|
Kunte C, Letulé V, Gehl J, Dahlstroem K, Curatolo P, Rotunno R, Muir T, Occhini A, Bertino G, Powell B, Saxinger W, Lechner G, Liew SH, Pritchard-Jones R, Rutkowski P, Zdzienicki M, Mowatt D, Sykes A, Orlando A, Mitsala G, Rossi C, Campana L, Brizio M, de Terlizzi F, Quaglino P, Odili J. Electrochemotherapy in the treatment of metastatic malignant melanoma: a prospective cohort study by InspECT. Br J Dermatol 2017; 176:1475-1485. [DOI: 10.1111/bjd.15340] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 12/16/2022]
Affiliation(s)
- C. Kunte
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - V. Letulé
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - J. Gehl
- Center for Experimental Drug and Gene Electrotransfer; Department of Oncology; Copenhagen University Hospital Herlev; Herlev Denmark
| | - K. Dahlstroem
- Department of Plastic Surgery; Copenhagen University Hospital Herlev; Denmark
| | - P. Curatolo
- Department of Dermatology and Plastic Surgery; Dermatologic Clinic; University of Rome ‘La Sapienza’; Rome Italy
| | - R. Rotunno
- Department of Dermatology and Plastic Surgery; Dermatologic Clinic; University of Rome ‘La Sapienza’; Rome Italy
| | - T. Muir
- Department of Reconstructive Plastic Surgery; James Cook University Hospital; Middlesbrough U.K
| | - A. Occhini
- Department of Otolaryngology Head & Neck Surgery; University of Pavia; IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - G. Bertino
- Department of Otolaryngology Head & Neck Surgery; University of Pavia; IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - B. Powell
- Department of Plastic Surgery; St George's Hospital; London U.K
| | - W. Saxinger
- Department of Dermatology; Klinikum Wels-Grieskirchen; Wels Austria
| | - G. Lechner
- Department of Dermatology; Klinikum Wels-Grieskirchen; Wels Austria
| | - S.-H. Liew
- Department of Plastic Surgery; Whiston Hospital; Prescot Merseyside U.K
| | | | - P. Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology; Warsaw Poland
| | - M. Zdzienicki
- Department of Soft Tissue/Bone Sarcoma and Melanoma; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology; Warsaw Poland
| | | | - A.J. Sykes
- Department of Clinical Oncology; Christie Hospital; NHS Foundation Trust; Manchester U.K
| | - A. Orlando
- Department of Plastic and Reconstructive Surgery; Southmead Hospital; North Bristol NHS Trust; Bristol U.K
| | - G. Mitsala
- Department of Plastic and Reconstructive Surgery; Southmead Hospital; North Bristol NHS Trust; Bristol U.K
| | - C.R. Rossi
- Veneto Institute of Oncology IOV-IRCCS; Padova Italy
- Department of Surgery, Oncology and Gastroenterology; University of Padova; Padova Italy
| | - L. Campana
- Veneto Institute of Oncology IOV-IRCCS; Padova Italy
- Department of Surgery, Oncology and Gastroenterology; University of Padova; Padova Italy
| | - M. Brizio
- Department of Medical Sciences; Dermatologic Clinic; University of Torino; Torino Italy
| | - F. de Terlizzi
- Scientific and Medical Department; IGEA S.p.A.; Carpi Italy
| | - P. Quaglino
- Department of Medical Sciences; Dermatologic Clinic; University of Torino; Torino Italy
| | - J. Odili
- Department of Plastic Surgery; St George's Hospital; London U.K
| | | |
Collapse
|
43
|
Rezaee Z, Yadollahpour A, Bayati V, Negad Dehbashi F. Gold nanoparticles and electroporation impose both separate and synergistic radiosensitizing effects in HT-29 tumor cells: an in vitro study. Int J Nanomedicine 2017; 12:1431-1439. [PMID: 28260889 PMCID: PMC5327907 DOI: 10.2147/ijn.s128996] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Radiation therapy (RT) is the gold standard treatment for more than half of known tumors. Despite recent improvements in RT efficiency, the side effects of ionizing radiation (IR) in normal tissues are a dose-limiting factor that restricts higher doses in tumor treatment. One approach to enhance the efficiency of RT is the application of radiosensitizers to selectively increase the dose at the tumor site. Gold nanoparticles (GNPs) and electroporation (EP) have shown good potential as radiosensitizers for RT. This study aims to investigate the sensitizing effects of EP, GNPs, and combined GNPs-EP on the dose enhancement factor (DEF) for 6 MV photon energy. METHODS Radiosensitizing effects of EP, GNPs, and combinations of GNPs-EP were comparatively investigated in vitro for intestinal colon cancer (HT-29) and Chinese hamster ovary (CHO) cell lines by MTT assay and colony formation assay at 6 MV photon energy in six groups: IR (control group), GNPs+IR, GNPs (24 h)+IR, EP+IR, GNPs+EP+IR, and GNPs (24 h)+EP+IR. RESULTS Treatment of both cell lines with EP, GNPs, and combined GNPs-EP significantly enhanced the response of cells to irradiation. However, the HT-29 showed higher DEF values for all groups. In addition, the DEF value for HT-29 cells for GNPs+IR, GNPs (24 h)+IR, EP+IR, GNPs+EP+IR, and GNPs (24 h)+EP+IR was, respectively, 1.17, 1.47, 1.36, 2.61, and 2.89, indicating synergistic radiosensitizing effect for the GNPs (24 h)+EP+IR group. Furthermore, the synergistic effect was observed just for HT-29 tumor cell lines. CONCLUSION Combined GNPs-EP protocols induced synergistic radiosensitizing effect in HT-29 cells, and the effect is also tumor specific. This combined therapy can be beneficially used for the treatment of intrinsically less radiosensitive tumors.
Collapse
Affiliation(s)
- Zohre Rezaee
- Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Avhaz, Iran
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Yadollahpour
- Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Avhaz, Iran
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Vahid Bayati
- Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Avhaz, Iran
| | - Fereshteh Negad Dehbashi
- Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Avhaz, Iran
| |
Collapse
|
44
|
Abstract
Anti-tumor electrochemotherapy, which consists in increasing anti-cancer drug uptake by means of electroporation, is now implanted in about 140 cancer treatment centers in Europe. Its use is supported by the English National Institute for Health and Care Excellence for the palliative treatment of skin metastases, and about 13,000 cancer patients were treated by this technology by the end of 2015. Efforts are now focused on turning this local anti-tumor treatment into a systemic one. Electrogenetherapy, that is the electroporation-mediated transfer of therapeutic genes, is currently under clinical evaluation and has brought excitement to enlarge the anti-cancer armamentarium. Among the promising electrogenetherapy strategies, DNA vaccination and cytokine-based immunotherapy aim at stimulating anti-tumor immunity. We review here the interests and state of development of both electrochemotherapy and electrogenetherapy. We then emphasize the potent beneficial outcome of the combination of electrochemotherapy with immunotherapy, such as immune checkpoint inhibitors or strategies based on electrogenetherapy, to simultaneously achieve excellent local debulking anti-tumor responses and systemic anti-metastatic effects.
Collapse
|
45
|
Campana LG, Matthiessen LW, Snoj M, Sersa G. Electrochemotherapy of Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
46
|
Campana L, Testori A, Curatolo P, Quaglino P, Mocellin S, Framarini M, Borgognoni L, Ascierto P, Mozzillo N, Guida M, Bucher S, Rotunno R, Marenco F, De Salvo G, De Paoli A, Rossi C, Bonadies A. Treatment efficacy with electrochemotherapy: A multi-institutional prospective observational study on 376 patients with superficial tumors. Eur J Surg Oncol 2016; 42:1914-1923. [DOI: 10.1016/j.ejso.2016.06.399] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 12/21/2022] Open
|
47
|
Bourke MG, Salwa SP, Sadadcharam M, Whelan MC, Forde PF, Larkin JO, Collins CG, O’Reilly S, O’Sullivan GC, Clover AJ, Soden DM. Effective treatment of intractable cutaneous metastases of breast cancer with electrochemotherapy: Ten-year audit of single centre experience. Breast Cancer Res Treat 2016; 161:289-297. [DOI: 10.1007/s10549-016-4046-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
|
48
|
Testori A, Ribero S, Bataille V. Diagnosis and treatment of in-transit melanoma metastases. Eur J Surg Oncol 2016; 43:544-560. [PMID: 27923593 DOI: 10.1016/j.ejso.2016.10.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 01/09/2023] Open
Abstract
In transit metastases (ITM) from extremity or trunk melanomas are subcutaneous or cutaneous lymphatic deposits of melanoma cells, distant from the primary site but not reaching the draining nodal basin. Superficial ITM metastases develop in 5-10% of melanoma patients and are thought to be caused by cells spreading along lymphatics; ITM appear biologically different from distant cutaneous metastases, these probably due to a haematogenous dissemination. The diagnosis is usually clinical and by patients, but patients need to be adequately educated in the recognition of this clinical situation. Ultrasound or more sophisticated instrumental devices may be required if the disease develops more deeply in the soft tissues. According to AJCC 2009 staging classification, ITM are included in stages IIIb and IIIc, which are considered local advanced disease with quite poor 5-year survival rates and outcomes of 24-54% at 5 years.2 Loco-regional recurrence is in fact an important risk factor for distant metastatic disease, either synchronous or metachronous. Therapy for this pattern of recurrence is less standardised then in most other clinical situations and options vary based on the volume and site of the disease. Definitive surgical resection remains the preferred therapeutic approach. However, when surgery cannot be performed with a reasonable cosmetic and functional outcome, other options must be utilized.3-6 Treatment options are classified as local, regional or systemic. The choice of therapy depends on the number of lesions, their anatomic location, whether or not these are dermal or subcutaneous, the size and the presence or absence of extra-regional disease.
Collapse
Affiliation(s)
- A Testori
- Divisione di Chirurgia Dermatoncologica, Istituto Europeo di Oncologia, Milano, Italy.
| | - S Ribero
- Dermatologia, Dipartimentto di Scienze mediche, Università di Torino, Italy
| | - V Bataille
- West Herts NHS Trust, London, UK; Mount Vernon Cancer Centre, Northwood, UK
| |
Collapse
|
49
|
Bertino G, Sersa G, De Terlizzi F, Occhini A, Plaschke CC, Groselj A, Langdon C, Grau JJ, McCaul JA, Heuveling D, Cemazar M, Strojan P, de Bree R, Leemans CR, Wessel I, Gehl J, Benazzo M. European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project: Results of the treatment of skin cancer. Eur J Cancer 2016; 63:41-52. [DOI: 10.1016/j.ejca.2016.05.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/15/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
|
50
|
Bhutiani N, Agle S, Li Y, Li S, Martin RCG. Irreversible electroporation enhances delivery of gemcitabine to pancreatic adenocarcinoma. J Surg Oncol 2016; 114:181-6. [PMID: 27393627 DOI: 10.1002/jso.24288] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/29/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Irreversible electroporation (IRE) utilizes short, high-voltage pulses to irreversibly permeabilize the cell membrane, resulting in apoptotic cell death. In addition to the irreversible zone, IRE creates a reversible zone that could be utilized for enhanced drug delivery. The hypothesis of this study is that a zone of reversible electroporation exists and allows for increased chemotherapy delivery. METHODS Ten immunocompromised mice with orthotopic human pancreatic adenocarcinoma tumors (Panc1) were treated with either IRE between two doses of gemcitabine (15 mg/kg) (ECT) (N = 5) or gemcitabine alone (N = 5). Gemcitabine levels in the serum, liver, and pancreas were analyzed with liquid chromatography/mass spectrometry (LC/MS). RESULTS Concentration of gemcitabine within reversibly electroporated pancreatic tissue was higher in mice receiving ECT compared to those receiving gemcitabine alone (13,567 ng/ml vs.4,126 ng/ml; P = 0.0009). Pancreatic gemcitabine levels were 5.52 and 5.96 times higher than liver and serum levels, respectively, in the ECT group compared to 2.85 and 2.53 times higher (P = 0.117, P = 0.058), respectively, in mice receiving gemcitabine alone. CONCLUSION IRE can potentially reduce local recurrence by allowing increased drug delivery to the tissue in the reversible electroporation zone. This holds significant potential in augmenting efficacy of gemcitabine in treatment of locally advanced and borderline resectable pancreatic adenocarcinoma. J. Surg. Oncol. 2016;114:181-186. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Neal Bhutiani
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Steven Agle
- Division of Surgical Oncology, Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Yan Li
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Suping Li
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Robert C G Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| |
Collapse
|