Electrochemotherapy in the Treatment of Head and Neck Cancer: Current Conditions and Future Directions

Abstract

Despite recent advances in the development of chemotherapeutic drug, treatment for advanced cancer of the head and neck cancer (HNC) is still challenging. Options are limited by multiple factors, such as a prior history of irradiation to the tumor site as well as functional limitations. Against this background, electrochemotherapy (ECT) is a new modality which combines administration of an antineoplastic agent with locally applied electric pulses. These pulses allow the chemotherapeutic drug to penetrate the intracellular space of the tumor cells and thereby increase its cytotoxicity. ECT has shown encouraging efficacy and a tolerable safety profile in many clinical studies, including in heavily pre-treated HNC patients, and is considered a promising strategy. Efforts to improve its efficacy and broaden its application are now ongoing. Moreover, the combination of ECT with recently developed novel therapies, including immunotherapy, represented by immune checkpoint inhibitor (ICI)s, has attracted attention for its potent theoretical rationale. More extensive, well-organized clinical studies and timely updating of consensus guidelines will bring this hopeful treatment to HNC patients under challenging situations.

Quality of Life in Electrochemotherapy for Cutaneous and Mucosal Head and Neck Tumors

“…In the last decade, ECT has successfully emerged as a treatment option in cutaneous and mucosal head and neck cancer [ 2 , 14 , 15 ]. The European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) multi-institutional project reported good outcomes both for skin and mucosal tumors [ 4 , 5 ].…”

VEGF Expression, Cellular Infiltration, and Intratumoral Collagen Levels after Electroporation-Based Treatment of Dogs with Cutaneous Squamous Cell Carcinoma

“…The combination of ECT plus immunotherapy, represented by immune checkpoint inhibitors, has been evaluated in humans with advanced cancer of the head and neck and non-melanoma skin cancer with potentially beneficial results [70,71]. This is important as ECT improves the local immune system and may stimulate the local infiltration of dendritic cells [72].…”

Elektrochemotherapie in der Hals-Nasen-Ohren-Heilkunde in Deutschland

“…Durch das kurzzeitige elektrische Feld erhöht sich temporär die Permeabilität der Zellmembran, sodass ein hydrophiles Chemotherapeutikum ins Zytoplasma eindringen kann [13]. Dies führt einerseits zu einer Schädigung der Tumorzellen, andererseits werden gesunde Zellen weitgehend geschont [2]. Als Chemotherapeutikum wird meist Bleomycin verwendet.…”

“…Außerdem wird die Apoptose in Endothelzellen des Tumorgewebes beeinflusst, tumorassoziierte Antigene werden freigesetzt und die lokale Immunantwort führt zur Ausrottung der verbliebenen lebensfähigen Tumorzellen [28]. Die Kombination mit Immuntherapien kann daher zu einer effektiveren Behandlung führen [2,29].…”

“…Die ECT ist eine lokalablative Therapieform, die Elektroporation dafür nutzt, dass ein Chemotherapeutikum in den Intrazellularraum der Tumorzellen eindringen und seine Zytotoxizität entfalten kann [2]. Dadurch können Tumoren effektiv therapiert werden bei einem guten Kosten-Nutzen-Verhältnis und relativ guter Verträglichkeit [3].…”