Palliative electrochemotherapy in primary or recurrent vulvar cancer

Corrado, Giacomo; Cutillo, Giuseppe; Fragomeni, Simona Maria; Bruno, Valentina; Tagliaferri, Luca; Mancini, Emanuela; Certelli, Camilla; Paris, Ida; Vizza, Enrico; Scambia, Giovanni; Garganese, Giorgia

doi:10.1136/ijgc-2019-001178

Cited by 25 publications

(27 citation statements)

References 21 publications

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“…Based on the ECT efficacy in the palliative treatment of skin metastasis, our group published in 2013 the first results on ECT in VC reporting with high local control rates (80%) and significant symptoms improvement [ 6 ]. Subsequently, other groups confirmed our results [ 7 , 39 ]. The most frequently treated histologic type was SCC, but data on few cases of melanoma and vulvar Paget’s disease were also promising.…”

Section: Principles Of Electrochemotherapy and The New Palliative Care In Vulvar Cancersupporting

confidence: 90%

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Electrochemotherapy in Vulvar Cancer and Cisplatin Combined with Electroporation. Systematic Review and In Vitro Studies

Perrone

Ravegnini

Miglietta

et al. 2021

Cancers

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Electrochemotherapy (ECT) is an emerging treatment for solid tumors and an attractive research field due to its clinical results. This therapy represents an alternative local treatment to the standard ones and is based on the tumor-directed delivery of non-ablative electrical pulses to maximize the action of specific cytotoxic drugs such as cisplatin (CSP) and bleomycin (BLM) and to promote cancer cell death. Nowadays, ECT is mainly recommended as palliative treatment. However, it can be applied to a wide range of superficial cancers, having an impact in preventing or delaying tumor progression and therefore in improving quality of life. In addition, during the natural history of the tumor, early ECT may improve patient outcomes. Our group has extensive clinical and research experience on ECT in vulvar tumors in the palliative setting, with 70% overall response rate. So far, in most studies, ECT was based on BLM. However, the potential of CSP in this setting seems interesting due to some theoretical advantages. The purpose of this report is to: (i) compare the efficacy of CSP and BLM-based ECT through a systematic literature review; (ii) report the results of our studies on CSP-resistant squamous cell tumors cell lines and the possibility to overcome chemoresistance using ECT; (iii) discuss the future ECT role in gynecological tumors and in particular in vulvar carcinoma.

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Section: Principles Of Electrochemotherapy and The New Palliative Care In Vulvar Cancersupporting

confidence: 90%

“…Unfortunately, even surgery and chemotherapy often do not meet this need. In this scenario, some research groups have proposed electrochemotherapy (ECT) to achieve local tumor control and symptoms relief based on the positive results recorded in skin tumors [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Electrochemotherapy in Vulvar Cancer and Cisplatin Combined with Electroporation. Systematic Review and In Vitro Studies

Perrone

Ravegnini

Miglietta

et al. 2021

Cancers

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“…Survival after one year in this population was observed at 50%. Electrochemotherapy may have a role in the management of vulvar cancer, especially as a palliative treatment when other therapies are no longer applicable [291]. However, technical issues mean that this tool is sporadically applied.…”

Section: Advancements In Vc Therapy Based On Better Profiling and Novmentioning

confidence: 99%

“…However, technical issues mean that this tool is sporadically applied. Conversely, CAP has received much more attention from researchers due to its ability to specifically induce the selective death of cancer cells over normal healthy cells, called antitumour selectivity [291][292][293], by activating the apoptosis of these cells, decreasing their proliferation and mobility, and by recovering their sensitivity to therapeutic drugs. Previous studies showed encouraging results where CAP returned cisplatin-resistant ovarian cancer cells [75], paclitaxel-resistant breast cancer cells [158], tamoxifen-resistant breast cancer cells [39], and temozolomide-resistant malignant glioma cells [294] to a drug-sensitive state, in addition to inducing apoptosis and growth inhibition.…”

Section: Advancements In Vc Therapy Based On Better Profiling and Novmentioning

confidence: 99%

Cold Atmospheric Pressure Plasma (CAP) as a New Tool for the Management of Vulva Cancer and Vulvar Premalignant Lesions in Gynaecological Oncology

Žúbor

Wang

Líšková

et al. 2020

IJMS

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Vulvar cancer (VC) is a specific form of malignancy accounting for 5–6% of all gynaecologic malignancies. Although VC occurs most commonly in women after 60 years of age, disease incidence has risen progressively in premenopausal women in recent decades. VC demonstrates particular features requiring well-adapted therapeutic approaches to avoid potential treatment-related complications. Significant improvements in disease-free survival and overall survival rates for patients diagnosed with post-stage I disease have been achieved by implementing a combination therapy consisting of radical surgical resection, systemic chemotherapy and/or radiotherapy. Achieving local control remains challenging. However, mostly due to specific anatomical conditions, the need for comprehensive surgical reconstruction and frequent post-operative healing complications. Novel therapeutic tools better adapted to VC particularities are essential for improving individual outcomes. To this end, cold atmospheric plasma (CAP) treatment is a promising option for VC, and is particularly appropriate for the local treatment of dysplastic lesions, early intraepithelial cancer, and invasive tumours. In addition, CAP also helps reduce inflammatory complications and improve wound healing. The application of CAP may realise either directly or indirectly utilising nanoparticle technologies. CAP has demonstrated remarkable treatment benefits for several malignant conditions, and has created new medical fields, such as “plasma medicine” and “plasma oncology”. This article highlights the benefits of CAP for the treatment of VC, VC pre-stages, and postsurgical wound complications. There has not yet been a published report of CAP on vulvar cancer cells, and so this review summarises the progress made in gynaecological oncology and in other cancers, and promotes an important, understudied area for future research. The paradigm shift from reactive to predictive, preventive and personalised medical approaches in overall VC management is also considered.

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“…The first clinical trial of electroporation in combination with chemotherapy (electrochemotherapy 'ECT') was performed in 1991 [3]. It has since been tested in clinical trials for treatment of vulval cancer [4,5], nonmelanoma skin cancer [6], cutaneous metastases [7,8] and tumours in internal organs [9,10]. When treated with ECT, tumour cells are selectively more sensitive than normal cells in vitro [11,12], thus preserving healthy tissue.…”

Section: Introductionmentioning

confidence: 99%

A novel application of calcium electroporation to cutaneous manifestations of gynaecological cancer

Ahmed-Salim¹,

Saso²,

Meehan³

et al. 2021

EJGO

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Calcium electroporation (CaEP) is a new technique whereby intracellular concentrations of calcium are elevated by transient permeabilisation of the cell membrane using high-voltage electrical pulses. Tumour necrosis is induced with little damage to healthy tissue. Within gynaecological cancer, vulval cancer and vulval intraepithelial neoplasia (VIN) pose challenges for treatment, given the high recurrence rate, persistent symptoms and repeated resections required. In certain cases, CaEP may provide a suitable alternative. Methods: We present a case series of six patients with recurrent vulval squamous cell carcinoma (n = 2), VIN III (n = 2) and metastatic ovarian cancer (n = 2), five of whom were treated with CaEP. This is the first known application of CaEP to gynaecological cancers. Results: The median follow-up time was 14 months (range 2-18 months). Within the cohort of patients, CaEP was applied a total of 10 times, achieving a complete response five times and partial response four times. Symptoms improved within six weeks for eight episodes following CaEP application. Beyond six weeks, symptoms eventually recurred in all patients and four patients required more than one CaEP procedure. CaEP was useful for palliation of distressing symptoms in one case of metastatic ovarian cancer. No intra-operative or post-operative complications have been reported to date. Conclusion: CaEP may be a promising shortterm treatment in selected patients with recurrent VIN and vulval cancer, where other treatments had failed. If validated, it could provide an acceptable alternative where surgery is unacceptable. Long term follow-up is required to evaluate effects on recurrence.

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Palliative electrochemotherapy in primary or recurrent vulvar cancer

Cited by 25 publications

References 21 publications

Electrochemotherapy in Vulvar Cancer and Cisplatin Combined with Electroporation. Systematic Review and In Vitro Studies

Electrochemotherapy in Vulvar Cancer and Cisplatin Combined with Electroporation. Systematic Review and In Vitro Studies

Cold Atmospheric Pressure Plasma (CAP) as a New Tool for the Management of Vulva Cancer and Vulvar Premalignant Lesions in Gynaecological Oncology

A novel application of calcium electroporation to cutaneous manifestations of gynaecological cancer

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