Electrochemotherapy – Emerging applications technical advances, new indications, combined approaches, and multi-institutional collaboration

Campana, Luca Giovanni; Edhemović, Ibrahim; Soden, Declan M.; Perrone, Anna Myriam; Scarpa, Marco; Campanacci, Laura; Čemažar, Maja; Valpione, Sara; Miklavčič, Damijan; Mocellin, Simone; Sieni, Elisabetta; Serša, Gregor

doi:10.1016/j.ejso.2018.11.023

Cited by 158 publications

(134 citation statements)

References 110 publications

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“…The results of this first-in-field study demonstrate that VEG-ECT can overcome two well-known limitations of standard ECT -large tumour size and deep anatomical location -and may represent an active and safe locoregional therapy for patients with soft tissue tumours when other treatments are not practicable. Over the last few years, electroporation-based procedures have evolved considerably 8,14 . Among the currently available approaches (standard ECT, irreversible electroporation [IRE], calcium electroporation, VEG-ECT and gene electrotransfer [GET]), standard ECT has become the most popular technique in clinical practice thanks to the ease of application, efficacy and safety coupled with an increasing number of indications 8,14 .…”

Section: Discussionmentioning

confidence: 99%

“…Over the last few years, electroporation-based procedures have evolved considerably 8,14 . Among the currently available approaches (standard ECT, irreversible electroporation [IRE], calcium electroporation, VEG-ECT and gene electrotransfer [GET]), standard ECT has become the most popular technique in clinical practice thanks to the ease of application, efficacy and safety coupled with an increasing number of indications 8,14 . However, the standard equipment does not allow targeting bulky (i.e., >3 cm) and deep-seated (i.e., >3 cm from the skin plane) tumours.…”

Section: Discussionmentioning

confidence: 99%

“…This observation suggests that researchers should exploit technical advancements aimed at reducing the invasiveness of the procedure (e.g. by reducing the number of probes through image-guided treatment planning or by using deployable electrode probes) to pursue future clinical application and maximise patient benefit 14 .…”

Section: Discussionmentioning

confidence: 99%

“…First, VEG-ECT entails the application of multiple electrodes, which could make the procedure cumbersome and time-consuming in some patients. This, nevertheless, soon could be overcome by the adoption of expandable catheters or more sophisticated tools for treatment planning 14 . Another concern relates to the insertion of relatively large probes and delivery of high voltages, which makes VEG-ECT more invasive and, conceivably, less tolerable compared to standard ECT.…”

Section: Discussionmentioning

confidence: 99%

“…These favourable results prompted further investigation and the development of new electrode probes, a dedicated pulse generator and, ultimately, a novel ECT modality, i.e. long needle variable electrode-geometry ECT (variable electrode-geometry ECT [VEG-ECT] herein on) 14 . Most notably, VEG-ECT takes advantage of needle electrodes, which are freely placeable and longer than those used in standard ECT.…”

mentioning

confidence: 99%

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Ablation of soft tissue tumours by long needle variable electrode-geometry electrochemotherapy: final report from a single-arm, single-centre phase-2 study

Simioni

Valpione

Granziera

et al. 2020

Sci Rep

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Standard electrochemotherapy (ECT) is effective in many tumour types but is confined to the treatment of small superficial lesions. Variable electrode-geometry ECT (VEG-ECT) may overcome these limitations by using long freely-placeable electrodes. Patients with bulky or deep-seated soft-tissue malignancies not amenable to resection participated in a single-arm phase-2 study (ISRCTN.11667954) and received a single course of VEG-ECT with intravenous bleomycin (15,000 IU/m 2) and concomitant electric pulses applied through an adjustable electrode array. The primary outcome was radiologic complete response rate (CRR) per RECIST; secondary endpoints included feasibility, metabolic response, toxicity (CTCAE), local progression-free survival (LPFS) and patient perception (EQ-5D). During 2009-2014, we enrolled 30 patients with trunk/limb sarcomas, melanoma, Merkel-cell carcinoma, and colorectal/lung cancer. Median tumour size was 4.7 cm. Electrode probes were placed under US/TC guidance (28 and 2 patients, respectively). Median procedure duration was 80 minutes. Tumour coverage rate was 97% (29 of 30 patients). Perioperative side-effects were negligible; one patient experienced grade-3 ulceration and infection. One-month 18 F-FDG-SUV decreased by 86%; CRR was 63% (95% CI 44-79%). Local control was durable in 24 of 30 patients (two-year LPFS, 62%). Patients reported an improvement in "usual activities", "anxiety/depression", and "overall health" scores. VEG-ECT demonstrated encouraging antitumour activity in soft-tissue malignancies; a single course of treatment produced high and durable responses, with low complications. Soft tissue metastases are a frequent event in patients with metastatic melanoma or soft tissue sarcomas (STS) but can also arise in those with breast, lung, and colon cancer 1,2. Although surgical resection remains the first therapeutic option, locoregional therapies are increasingly being considered by the oncology team with either curative or palliative intent 3-5. Moreover, the introduction of new active systemic agents has revamped the interest in locoregional therapies and their possible integration into synergistic therapeutic strategies 6,7. Over the last decade, electrochemotherapy (ECT) has demonstrated efficacy across a great variety of superficial malignancies, including melanoma, breast, head and neck and gynecologic cancers 8. In ECT, targeted electric pulses are administered employing small, fixed-geometry electrodes to attain reversible cell membrane

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Ablation of soft tissue tumours by long needle variable electrode-geometry electrochemotherapy: final report from a single-arm, single-centre phase-2 study

Simioni

Valpione

Granziera

et al. 2020

Sci Rep

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Electrotherapies for Glioblastoma

et al. 2021

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Non-thermal, intermediate frequency (100-500 kHz) electrotherapies present a unique therapeutic strategy to treat malignant neoplasms. Here, pulsed electric fields (PEFs) which induce reversible or irreversible electroporation (IRE) and tumour-treating fields (TTFs) are reviewed highlighting the foundations, advances, and considerations of each method when applied to glioblastoma (GBM). Several biological aspects of GBM that contribute to treatment complexity (heterogeneity, recurrence, resistance, and blood-brain barrier(BBB)) and electrophysiological traits which are suggested to promote glioma progression are described. Particularly, the biological responses at the cellular and molecular level to specific parameters of the electrical stimuli are discussed offering ways to compare these parameters despite the lack of a universally adopted physical description. Reviewing the literature, a disconnect is found between electrotherapy techniques and how they target the biological complexities of GBM that make treatment difficult in the first place. An attempt is made to bridge the interdisciplinary gap by mapping biological characteristics to different methods of electrotherapy, suggesting important future research topics and directions in both understanding and treating GBM. To the authors' knowledge, this is the first paper that attempts an in-tandem assessment of the biological effects of different aspects of intermediate frequency electrotherapy methods, thus offering possible strategies toward GBM treatment.

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The effect of local non‐thermal plasma therapy on the cancer‐immunity cycle in a melanoma mouse model

Lin

Backer

Quatannens

et al. 2022

Bioengineering & Transla Med

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Melanoma remains a deadly cancer despite significant advances in immune checkpoint blockade and targeted therapies. The incidence of melanoma is also growing worldwide, which highlights the need for novel treatment options and strategic combination of therapies. Here, we investigate non-thermal plasma (NTP), an ionized gas, as a promising, therapeutic option. In a melanoma mouse model, direct treatment of tumors with NTP results in reduced tumor burden and prolonged survival. Physical characterization of NTP treatment in situ reveals the deposited NTP energy and temperature associated with therapy response, and whole transcriptome analysis of the tumor identified several modulated pathways. NTP treatment also enhances the cancer-immunity cycle, as immune cells in both the tumor and tumor-draining lymph nodes appear more stimulated to perform their anti-cancer functions. Thus, our data suggest that local NTP therapy stimulates systemic, anti-cancer immunity. We discuss, in detail, how these fundamental insights will help direct the translation of NTP technology into the clinic and inform rational combination strategies to address the challenges in melanoma therapy.

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Electrochemotherapy – Emerging applications technical advances, new indications, combined approaches, and multi-institutional collaboration

Cited by 158 publications

References 110 publications

Ablation of soft tissue tumours by long needle variable electrode-geometry electrochemotherapy: final report from a single-arm, single-centre phase-2 study

Ablation of soft tissue tumours by long needle variable electrode-geometry electrochemotherapy: final report from a single-arm, single-centre phase-2 study

Electrotherapies for Glioblastoma

The effect of local non‐thermal plasma therapy on the cancer‐immunity cycle in a melanoma mouse model

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