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)

Clover, A. James P.; Terlizzi, Francesca de; Bertino, Giulia; Curatolo, P.; Odili, Joy; Campana, Luca Giovanni; Kunte, Christian; Muir, Tobian; Brizio, Matteo; Serša, Gregor; Jones, Rowan Pritchard; Moir, Graeme; Orlando, Antonio; Banerjee, S.; Kis, Erika; McCaul, Jim; Grischke, Eva‐Maria; Matteucci, Paolo; Mowatt, David; Bechara, Falk G.; Mascherini, Matteo; Liço, V.; Giorgione, Roberto; Seccia, Veronica; Schepler, Hadrian; Pecorari, Giancarlo; Ross, Alastair D. MacKenzie; Bisase, Brian; Gehl, Julie

doi:10.1016/j.ejca.2020.06.020

Cited by 79 publications

(106 citation statements)

References 31 publications

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“…The electrode can then be subsequently inserted in a systematic way to cover the entire tumour volume, as indicated in figure part E. As can be seen, the treatment area then covers the tumour with treatment margin. Open access cutaneous tumours, 35 which supports the use of this electrode. The maximum current delivered during treatment as measured by the pulse generator will be noted for each tumour.…”

Section: Applied Electric Pulsessupporting

confidence: 56%

“…We use linear array needle electrodes, which are superior in treatment of smaller tumours in the skin, to plate and hexagonal needle electrodes. 35 Pulses will be administered immediately after calcium injection, repositioning the electrode in an adjacent fashion to ensure an even distribution of treatment throughout the tumour ( figure 5 ). The needle application leaves small barely visible punctuations of the skin further allowing the treating clinician to keep track of treatment.…”

Section: Ethics Safety and Disseminationmentioning

confidence: 99%

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Study protocol designed to investigate tumour response to calcium electroporation in cancers affecting the skin: a non-randomised phase II clinical trial

et al. 2021

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IntroductionSkin malignancy is a distressing problem for many patients, and clinical management is challenging. This article describes the protocol for the Calcium Electroporation Response Study (CaEP-R) designed to investigate tumour response to calcium electroporation and is a descriptive guide to calcium electroporation treatment of malignant tumours in the skin. Calcium electroporation is a local treatment that induces supraphysiological intracellular calcium levels by intratumoural calcium administration and application of electrical pulses. The pulses create transient membrane pores allowing diffusion of non-permeant calcium ions into target cells. High calcium levels can kill cancer cells, while normal cells can restore homeostasis. Prior trials with smaller cohorts have found calcium electroporation to be safe and efficient. This trial aims to include a larger multiregional cohort of patients with different cancer diagnoses and also to investigate treatment areas using MRI as well as assess impact on quality of life.Methods and analysisThis non-randomised phase II multicentre study will investigate response to calcium electroporation in 30 patients with cutaneous or subcutaneous malignancy. Enrolment of 10 patients is planned at three centres: Zealand University Hospital, University Hospital of Southern Denmark and University Hospital Schleswig-Holstein. Response after 2 months was chosen as the primary endpoint based on short-term response rates observed in a prior clinical study. Secondary endpoints include response to treatment using MRI and change in quality of life assessed by questionnaires and qualitative interviews.Ethics and disseminationThe trial is approved by the Danish Medicines Agency and The Danish Regional Committee on Health Research Ethics. All included patients will receive active treatment (calcium electroporation). Patients can continue systemic treatment during the study, and side effects are expected to be limited. Data will be published in a peer-reviewed journal and made available to the public.Trial registration numbersNCT04225767 and EudraCT no: 2019-004314-34.

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Section: Applied Electric Pulsessupporting

confidence: 56%

Section: Ethics Safety and Disseminationmentioning

confidence: 99%

Study protocol designed to investigate tumour response to calcium electroporation in cancers affecting the skin: a non-randomised phase II clinical trial

et al. 2021

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“…Instead, Mali et al [ 109 ] proposed a 2 cm cut-off, which was shown to be associated with the most significant complete response. More recently, an analysis of the InspECT registry (2482 lesions in 987 patients) [ 112 ] documented a steady progressive decrease in the complete response with the increase in tumor size, with rates consistently higher than 70% for tumors up to 1.5 cm in size. Recent evidence indicates that preirradiated tumors have a significantly lower response rate to ECT [ 110 ].…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review about Imaging and Histopathological Findings for Detecting and Evaluating Electroporation Based Treatments Response

Granata

Fusco

Salati

et al. 2021

IJERPH

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Background: Imaging methods and the most appropriate criteria to be used for detecting and evaluating response to oncological treatments depend on the pathology and anatomical site to be treated and on the treatment to be performed. This document provides a general overview of the main imaging and histopathological findings of electroporation-based treatments (Electrochemotherapy—ECT and Irreversible electroporation—IRE) compared to thermal approach, such as radiofrequency ablation (RFA), in deep-seated cancers with a particular attention to pancreatic and liver cancer. Methods: Numerous electronic datasets were examined: PubMed, Scopus, Web of Science and Google Scholar. The research covered the years from January 1990 to April 2021. All titles and abstracts were analyzed. The inclusion criteria were the following: studies that report imaging or histopathological findings after ablative thermal and not thermal loco-regional treatments (ECT, IRE, RFA) in deep-seated cancers including pancreatic and liver cancer and articles published in the English language. Exclusion criteria were unavailability of full text and congress abstracts or posters and different topic respect to inclusion criteria. Results: 558 potentially relevant references through electronic searches were identified. A total of 38 articles met the inclusion criteria: 20 studies report imaging findings after RFA or ECT or IRE in pancreatic and liver cancer; 17 studies report histopathological findings after RFA or ECT or IRE; 1 study reports both imaging and histopathological findings after RFA or ECT or IRE. Conclusions: Imaging features are related to the type of therapy administrated, to the timing of re-assessment post therapy and to the imaging technique being used to observe the effects. Histological findings after both ECT and IRE show that the treated area becomes necrotic and encapsulated in fibrous tissue, suggesting that the size of the treated lesion cannot be measured as an endpoint to detect response. Moreover, histology frequently reported signs of apoptosis and reduced vital tissue, implying that imaging criteria, which take into account the viability and not the size of the lesion, are more appropriate to evaluate response to treatment.

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“…Electrochemotherapy (ECT) is a methodology able to couple the “electroporation” of the cell membranes with the concomitant administration of antineoplastic drugs. Electroporation consists of the application of short-intensity pulsed electric fields to tumor cells, following which, the plasma membrane permeability to different hydrophilic drugs transiently increases, thus facilitating cellular uptake of cytotoxic agents [ 55 , 56 , 57 , 58 ]. ECT acts through three main mechanisms, namely, the so called “vascular lock”, which consists of a vascular spasm able to interrupt the tumor bleeding and to a prolong contact time between the antineoplastic drug and the tumor tissues; the second mechanism is the direct action of the drug with the cancer cells DNA, which leads to DNA damage and quick apoptosis; finally, the most interesting one regards the induction of the “immunogenic cell death” (ICD), which is characterized by the tissue expression of different immunogenic antigens and a strong recruitment of DC and APC.…”

Section: The Role Of Electrochemotherapymentioning

confidence: 99%

Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck: A Big and Intriguing Challenge Which May Be Resolved by Integrated Treatments Combining Locoregional and Systemic Therapies

Ionna¹,

Bossi

Guida³

et al. 2021

Cancers

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Squamous cell carcinoma of the head and neck (SCCHN) is a complex group of malignancies, posing several challenges to treating physicians. Most patients are diagnosed with a locally advanced disease and treated with strategies integrating surgery, chemotherapy, and radiotherapy. About 50% of these patients will experience a recurrence of disease. Recurrent/metastatic SCCHN have poor prognosis with a median survival of about 12 months despite treatments. In the last years, the strategy to manage recurrent/metastatic SCCHN has profoundly evolved. Salvage treatments (surgery or re-irradiation) are commonly employed in patients suffering from locoregional recurrences and their role has gained more and more importance in the last years. Re-irradiation, using some particularly fractionating schedules, has the dual task of reducing the tumor mass and eliciting an immune response against cancer (abscopal effect). In this review, we will analyze the main systemic and/or locoregional strategies aimed at facing the recurrent/metastatic disease, underlining the enormous importance of the multidisciplinary approach in these types of patients.

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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)

Cited by 79 publications

References 31 publications

Study protocol designed to investigate tumour response to calcium electroporation in cancers affecting the skin: a non-randomised phase II clinical trial

Study protocol designed to investigate tumour response to calcium electroporation in cancers affecting the skin: a non-randomised phase II clinical trial

A Systematic Review about Imaging and Histopathological Findings for Detecting and Evaluating Electroporation Based Treatments Response

Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck: A Big and Intriguing Challenge Which May Be Resolved by Integrated Treatments Combining Locoregional and Systemic Therapies

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