Treatment efficacy with electrochemotherapy: A multi-institutional prospective observational study on 376 patients with superficial tumors

Campana, Luca Giovanni; Testori, Alessandro; Curatolo, Paolo; Quaglino, Pietro; Mocellin, Simone; Framarini, Massimo; Borgognoni, Lorenzo; Ascierto, Paolo A.; Mozzillo, Nicola; Guida, Michele; Bucher, S.; Rotunno, Roberta; Marenco, Federica; Salvo, Gian Luca De; Paoli, Angela De; Rossi, Carlo Riccardo; Bonadies, A

doi:10.1016/j.ejso.2016.06.399

Cited by 106 publications

(103 citation statements)

References 34 publications

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“…In a large international prospectively registry, we identified 57 ECT patients who were administered reduced BLM doses and analysed their outcomes. In this cohort, tumour response data (per‐tumour ORR, 84% and per‐patient ORR, 80%) are in agreement with results achieved by administering the standard BLM dose, as reported in the most recent ECT experiences …”

Section: Discussionsupporting

confidence: 88%

Electrochemotherapy of unresectable cutaneous tumours with reduced dosages of intravenous bleomycin: analysis of 57 patients from the International Network for Sharing Practices of Electrochemotherapy registry

Rotunno

Campana

Quaglino

et al. 2017

Acad Dermatol Venereol

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Section: Discussionsupporting

confidence: 88%

Electrochemotherapy of unresectable cutaneous tumours with reduced dosages of intravenous bleomycin: analysis of 57 patients from the International Network for Sharing Practices of Electrochemotherapy registry

Rotunno

Campana

Quaglino

et al. 2017

Acad Dermatol Venereol

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“…A recent meta-analysis assessing 47 prospective studies on patients with cutaneous metastases—mainly from melanoma and breast cancer—treated by skin-directed therapies (including ECT, radiation, photodynamic, intralesional and topical therapies) showed sustained response rates across treatments with G ≥ 3 dermatological toxicity in less than 6% of patients [26]. More recently, a European and an Italian multicenter studies (both adopting the ESOPE protocol), have reported CR rates of 91 and 66.7%, respectively, in BCC patients, although with a short follow-up (6 and 13.9 months, respectively) [10, 11]. In 2016, Rotunno et al reported a 75% CR rate in patients with head and neck BCC treated by ECT.…”

Section: Discussionmentioning

confidence: 99%

“…It included BCC-specific parameters (histological subtypes, tumor borders, ulceration) in order to personalize treatment indication. It was conducted at a center, which is long acquainted with the procedure [8, 9, 11, 39]. Finally, it has a relatively long follow-up, which is crucial for assessing late recurrences [28, 43].…”

Section: Discussionmentioning

confidence: 99%

Basal cell carcinoma: 10-year experience with electrochemotherapy

et al. 2017

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BackgroundElectrochemotherapy (ECT), by combining manageable cytotoxic agents with short electric pulses, represents an effective palliative skin-directed therapy. The accumulated evidence indicates that ECT stands out as a safe and well-tolerated alternative treatment for patients with multiple or large basal cell carcinoma (BCC), who are not suitable for conventional treatments. However, long-term data and shared indications are lacking.MethodsIn this observational study, we retrospectively analyzed 84 prospectively collected patients with multiple, recurrent or locally advanced BCC who were not candidate for standard therapies and received bleomycin-based ECT according to the European Standard Operative Procedures of ECT, from 2006 to 2016.ResultsDisease extent was local, locally advanced and metastatic in 40 (48%), 41 (49%) and 3 (3%), respectively. Forty-four (52%) individuals had multiple BCCs. Grade 3 skin toxicity after ECT was observed in 6% of cases. Clearance rate was 50% (95% CI 39–61%). Primary presentation (p = 0.004), tumor size <3 cm (p < 0.001), well-defined borders (p = 0.021), absence of tumor ulceration (p = 0.001), non-aggressive BCC histology (p = 0.046) and age ≤69 years were associated with higher complete response rate. In patients with local BCC, the clearance rate was 72.5 and 85% after one or two ECT cycles, respectively. In the laBCC group, 32 patients (78%) achieved an objective response. Five-year recurrence rate for local and laBCC was 20 and 38%, respectively (p ≤ 0.001).ConclusionsOne or two ECT cycles with bleomycin may be a valuable palliative treatment in well-selected patients with multiple BCCs and favorable tumor features. Validation of predictive factors will be imperative to match patients with optimal ECT treatment modalities. Management of laBCC with ECT warrants further investigation. Trial registration ISRCTN14633165 Registered 24 March 2017 (retrospectively registered)Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-017-1225-5) contains supplementary material, which is available to authorized users.

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“…Several clinical studies have demonstrated the safety and efficacy of ECT in the tumor control of a wide range of primary and metastatic malignancies 6–8,13. In particular, ECT has been shown to be a safe and effective treatment option in a palliative setting for melanoma cutaneous and subcutaneous metastases 14–16.…”

Section: Discussionmentioning

confidence: 99%

Electrochemotherapy induces apoptotic death in melanoma metastases: a histologic and immunohistochemical investigation

Bigi¹,

Galdo²,

Cesinaro³

et al. 2016

CCID

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BackgroundElectrochemotherapy (ECT) is increasingly used in the treatment of primary and secondary skin tumors, but little is known about the pathologic mechanism responsible for tumor cell destruction in humans. Knowledge of detailed mechanism of host response after ECT may improve the treatment efficacy related to patient selection and technique refinements.AimThe aim of the study was to investigate the histopathology and mechanism of cell death after ECT in cutaneous melanoma metastases.MethodsSkin biopsy specimens were sequentially obtained after ECT of cutaneous melanoma metastases, during a follow-up period of 2 months. Results from histologic evaluation and immunohistochemical characterization of the inflammatory infiltrate (CD3, CD4, CD8, CD56, Granzyme-B) were compared with a panel of apoptosis-related markers.Main outcome measuresEvidence of the mechanism of tumor cell damage, identification of histological and immunohistochemical signs of apoptosis and/or necrosis underlining a possible time course of tumor destruction and inflammatory reaction after ECT.ResultsEarly signs of epidermal degeneration, an increase of the inflammatory infiltrate, and initial tumor cell morphological changes were already detected 10 min after ECT. The cell damage progression, as demonstrated by histological and immunohistochemical evidence using apoptotic markers (TUNEL and caspase-3 staining), reached a climax 3 days after treatment, to continue until 10 days after. Scarring fibrosis and complete absence of tumor cells were observed in the late biopsy specimens. A rich inflammatory infiltrate with a prevalence of T-cytotoxic CD3/CD8-positive cells was detected 3 h after ECT and was still appreciable 3 months later.ConclusionThis study attempts to define the time course and characteristics of tumor response to ECT. The observations suggest both a direct necrotic cell damage and a rapid activation of apoptotic mechanisms that occur in the early phases of the cutaneous reaction to ECT. A persistent immune response of T-cytotoxic lymphocytes could possibly explain the long-term local tumor control.

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Treatment efficacy with electrochemotherapy: A multi-institutional prospective observational study on 376 patients with superficial tumors

Abstract: ECT represents a valuable skin-directed therapy across a range of malignancies. The most frequently applied treatment modality is intravenous chemotherapy under sedation. Small tumor size predicts durable tumor control, fewer side-effects and better PROs.

Cited by 106 publications

References 34 publications

Electrochemotherapy of unresectable cutaneous tumours with reduced dosages of intravenous bleomycin: analysis of 57 patients from the International Network for Sharing Practices of Electrochemotherapy registry

Electrochemotherapy of unresectable cutaneous tumours with reduced dosages of intravenous bleomycin: analysis of 57 patients from the International Network for Sharing Practices of Electrochemotherapy registry

Basal cell carcinoma: 10-year experience with electrochemotherapy

Electrochemotherapy induces apoptotic death in melanoma metastases: a histologic and immunohistochemical investigation

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