Recent progress in pulsed electric field ablation for liver cancer

Liu, Zhenguo; Chen, Xinhua; Yu, Zujiang; Lv, Jun; Ren, Zhigang

doi:10.3748/wjg.v26.i24.3421

Cited by 16 publications

(11 citation statements)

References 88 publications

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“…Clinical applications of IRE are growing, especially for the treatment of liver and pancreatic cancers, and show that IRE represents a safe therapeutic approach, and that the application of this technique may improve patient survival and quality of life [40][41][42][43][44]. Furthermore, applications in the therapy of other tumors are reported.…”

Section: Electroporation-based Therapiesmentioning

confidence: 99%

“…If local application in a target tissue is combined with systemic or the local administration of a drug with a low capacity for permeation through the cell membrane, this capacity is locally improved. Thus, the drug can come inside the cell and can explain its therapeutic effect, especially where an electric field is applied [43]. The result is drug targeting.…”

Section: Electroporation-based Therapiesmentioning

confidence: 99%

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Electrochemotherapy of Deep-Seated Tumors: State of Art and Perspectives as Possible “EPR Effect Enhancer” to Improve Cancer Nanomedicine Efficacy

Bonferoni

Rassu

Gavini

et al. 2021

Cancers

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Surgical resection is the gold standard for the treatment of many kinds of tumor, but its success depends on the early diagnosis and the absence of metastases. However, many deep-seated tumors (liver, pancreas, for example) are often unresectable at the time of diagnosis. Chemotherapies and radiotherapies are a second line for cancer treatment. The “enhanced permeability and retention” (EPR) effect is believed to play a fundamental role in the passive uptake of drug-loaded nanocarriers, for example polymeric nanoparticles, in deep-seated tumors. However, criticisms of the EPR effect were recently raised, particularly in advanced human cancers: obstructed blood vessels and suppressed blood flow determine a heterogeneity of the EPR effect, with negative consequences on nanocarrier accumulation, retention, and intratumoral distribution. Therefore, to improve the nanomedicine uptake, there is a strong need for “EPR enhancers”. Electrochemotherapy represents an important tool for the treatment of deep-seated tumors, usually combined with the systemic (intravenous) administration of anticancer drugs, such as bleomycin or cisplatin. A possible new strategy, worthy of investigation, could be the use of this technique as an “EPR enhancer” of a target tumor, combined with the intratumoral administration of drug-loaded nanoparticles. This is a general overview of the rational basis for which EP could be envisaged as an “EPR enhancer” in nanomedicine.

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Section: Electroporation-based Therapiesmentioning

confidence: 99%

Section: Electroporation-based Therapiesmentioning

confidence: 99%

Electrochemotherapy of Deep-Seated Tumors: State of Art and Perspectives as Possible “EPR Effect Enhancer” to Improve Cancer Nanomedicine Efficacy

Bonferoni

Rassu

Gavini

et al. 2021

Cancers

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“…IRE has been generally used in HCC cases where thermal ablation was considered unsuitable or at high risk of complications including the setting of bridge to transplantation [ 178 , 179 , 180 ]. Regarding efficacy, a recent review of nine major studies focused on IRE in the treatment of liver cancers (the majority being HCC) reported a primary efficacy rate of 66–100%, a local recurrence rate of 5–34%, and general and major complication rates of 11–42% and 3–11%, respectively [ 181 ].…”

Section: Ablation Techniques Under Evaluationmentioning

confidence: 99%

Interventional Radiology Image-Guided Locoregional Therapies (LRTs) and Immunotherapy for the Treatment of HCC

Biondetti

Saggiante

Ierardi

et al. 2021

Cancers

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Image-guided locoregional therapies (LRTs) are a crucial asset in the treatment of hepatocellular carcinoma (HCC), which has proven to be characterized by an impaired antitumor immune status. LRTs not only directly destroy tumor cells but also have an immunomodulating role, altering the tumor microenvironment with potential systemic effects. Nevertheless, the immune activation against HCC induced by LRTs is not strong enough on its own to generate a systemic significant antitumor response, and it is incapable of preventing tumor recurrence. Currently, there is great interest in the possibility of combining LRTs with immunotherapy for HCC, as this combination may result in a mutually beneficial and synergistic relationship. On the one hand, immunotherapy could amplify and prolong the antitumoral immune response of LRTs, reducing recurrence cases and improving outcome. On the other hand, LTRs counteract the typical immunosuppressive HCC microenvironment and status and could therefore enhance the efficacy of immunotherapy. Here, after reviewing the current therapeutic options for HCC, we focus on LRTs, describing for each of them the technique and data on its effect on the immune system. Then, we describe the current status of immunotherapy and finally report the recently published and ongoing clinical studies testing this combination.

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“…As opposed to thermal ablative techniques, IRE induces cell death via the delivery of high-voltage short electrical pulses (EPs) and possesses several advantages as a non-thermal ablation technique: a) less collateral thermal damage, especially for vital nerves, vessels, and cavity structures; b) no heat sink effect, avoiding incomplete ablation due to the energy reduction caused by blood flow; and c) preservation of the extracellular matrix (ECM) scaffold, promoting rapid postoperative recovery (10,11). Currently, IRE is performed mostly for solid tumors such as liver cancer (12), pancreatic cancer (13), and prostate cancer (8) and provides an advantageous palliative treatment for advanced tumors in the vicinity of important ductal structures, such as large blood vessels, the intestines, bile ducts, or the urinary tract. However, the uneven distribution of the PEF, resulting from the heterogeneous electrical properties of tumor tissue (14,15), leads to incomplete ablation and increases the risk of tumor recurrence, which limits the popularity of IRE in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Irreversible Electroporation: An Emerging Immunomodulatory Therapy on Solid Tumors

Zhang

Han

et al. 2022

Front. Immunol.

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Irreversible electroporation (IRE), a novel non-thermal ablation technique, is utilized to ablate unresectable solid tumors and demonstrates favorable safety and efficacy in the clinic. IRE applies electric pulses to alter the cell transmembrane voltage and causes nanometer-sized membrane defects or pores in the cells, which leads to loss of cell homeostasis and ultimately results in cell death. The major drawbacks of IRE are incomplete ablation and susceptibility to recurrence, which limit its clinical application. Recent studies have shown that IRE promotes the massive release of intracellular concealed tumor antigens that become an “in-situ tumor vaccine,” inducing a potential antitumor immune response to kill residual tumor cells after ablation and inhibiting local recurrence and distant metastasis. Therefore, IRE can be regarded as a potential immunomodulatory therapy, and combined with immunotherapy, it can exhibit synergistic treatment effects on malignant tumors, which provides broad application prospects for tumor treatment. This work reviewed the current status of the clinical efficacy of IRE in tumor treatment, summarized the characteristics of local and systemic immune responses induced by IRE in tumor-bearing organisms, and analyzed the specific mechanisms of the IRE-induced immune response. Moreover, we reviewed the current research progress of IRE combined with immunotherapy in the treatment of solid tumors. Based on the findings, we present deficiencies of current preclinical studies of animal models and analyze possible reasons and solutions. We also propose possible demands for clinical research. This review aimed to provide theoretical and practical guidance for the combination of IRE with immunotherapy in the treatment of malignant tumors.

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Recent progress in pulsed electric field ablation for liver cancer

Cited by 16 publications

References 88 publications

Electrochemotherapy of Deep-Seated Tumors: State of Art and Perspectives as Possible “EPR Effect Enhancer” to Improve Cancer Nanomedicine Efficacy

Electrochemotherapy of Deep-Seated Tumors: State of Art and Perspectives as Possible “EPR Effect Enhancer” to Improve Cancer Nanomedicine Efficacy

Interventional Radiology Image-Guided Locoregional Therapies (LRTs) and Immunotherapy for the Treatment of HCC

Irreversible Electroporation: An Emerging Immunomodulatory Therapy on Solid Tumors

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