Electrochemotherapy of skin metastases from malignant melanoma: a PRISMA-compliant systematic review

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.

Invasive and non-invasive electrodes for successful drug and gene delivery in electroporation-based treatments

“…The mentioned factors may cause discomfort for patients. Nonetheless, ECT may offer an effective treatment for cancerous skin lesions: basal cell carcinoma, 100% complete response within 15–56 months ( Kis et al, 2019 ); melanoma metastases, 89% complete response within 24 months ( Ricotti et al, 2014 ) and 60% complete response within 6 months ( Matthiessen et al, 2011 ); and malignant melanoma, 53.5% ( Ferioli et al, 2022 ). Partial or negative tumor response may potentially be associated with inappropriate drug concentration, non-uniform PEF distribution, and other factors, including immune response to the treatment ( Sersa et al, 2008b ; Cadossi et al, 2014 ).…”

Electrochemotherapy with intravenous bleomycin for heavily pre-treated vulvar cancer patients

“…Electrochemotherapy is a combined modality treatment based on electroporation plus concurrent chemotherapy, usually bleomycin, administered intravenously. Electrochemotherapy is mainly used in the palliative setting of skin tumors and metastases7–9 and, more recently, of vulvar cancer 10–12. Recent studies have shown that patients with vulvar cancer relapse and without additional standard treatment options show response rates of approximately 80% after electrochemotherapy 13–15.…”

High-Frequency Electroporation and Chemotherapy for the Treatment of Cutaneous Malignancies: Evaluation of Early Clinical Response

“…The efficacy of ECT as a treatment has been well demonstrated following the publication of outcome analyses collated from cancer centres across Europe, all demonstrating good response rates [ 1 , 9 , 10 ]. Furthermore, outcome analysis with regards to cutaneous malignancy histiotypes demonstrates the efficacy of ECT across multiple tumour types, including melanoma [ 11 , 12 ], breast cancer [ 13 , 14 ], and basal cell carcinomas (BCCs) [ 15 , 16 ], establishing ECT as a recognised treatment option contributing to the multi-disciplinary management of a variety of cutaneous malignancies.…”