Abstract
Electrochemotherapy (ECT) is a therapeutical procedure based on the induction of cell membrane electroporation, by cell exposure to electric fields lasting a few microseconds, combined with the local or systemic administration of cytotoxic drugs, with an intracellular target and high intrinsic efficacy, but poor cell membrane permeability. ECT is an effective local therapy for any histological tumour that has been used clinically since 2005 and is currently in use in 83 centres all over Europe. In the literature, ECT as a local oncological treatment shows an objective response between 70 and 90% in mucocutaneous primary and metastatic lesions, is cost effective and has few local and systemic side effects. In this manuscript, we present an overview of the European experience in ECT, as well as our own experience in a specialised Spanish oncological centre and in a basic oncological unit in Nicaragua. The purpose is to reflect on the role that this procedure could have in the treatment of skin and mucosal cancer as part of a multidisciplinary approach.
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References
Weaber J, Powell K (1989) Theory of electroporation. In Neumann E, Sowers E, Jordan C (eds) Electrofusion in cell biology. Plenum Press, New York, pp 111–127
Neumann E, Rosenheck K (1972) Permeability changes induced by electric impulses in vesicular membranes. J Membr Biol 29:279–290
Kirosita K, Tseng T (1977) Formation and resealing of pores of controlled sizes in human erythrocytes membrane. Nature 268:438–448
Mir Ll (2006) Standard operating procedures of electrochemotherapy: instructions for the use of bleomycin or cisplatin administered either systemically or locally and electric pulses delivered by the Cliniporator™ by means of invasive or non-invasive electrodes. Eur J Cancer Suppl 4:14–15
Orlowski S, Belehradek J, Paoletti C (1991) Transient electropermeabilization of cells in culture increase of cytotoxicity of anticancer drugs. Biochem Pharmacol 37:4727–4733
Mir L, Banoun H, Paoletti C (2000) Introduction of definite amount of nonpermeant molecules into living cells after electropermeabilization direct access to the cytosol. Exp Cell Res 175:15–25
Pron G, Belehradek J, Mir Ll (1994) Identification of a plasma membrane protein that specifically binds bleomycin. Biochem Biophys Res Commun 194:333–337
Pron G, Mahrour N, Orlowski S et al (1999) Internalisation of the bleomycin molecules responsible for bleomycin toxicity: a receptor-mediated endocytosis mechanism. Biochem Pharmacol 57:45–56
Marty M, Sersa G, Garbay J et al (2006) Electrochemotherapy: an easy, highly effective and safe treatment of cutaneous and subcutaneous metastases: results of ESOPE (European Standard Operating Procedures of Electrochemotherapy) study. EJC Suppl 4:3–13
Sersa G, Stabuc B, Cemazar M et al (2000) Electrochemotherapy with cisplatin: clinical experience in malignant melanoma patients. Clin Cancer Res 6:863–867
Mir Ll (2006) Electrochemotherapy: introduction. EJC Suppl 4:1–2
Muñoz V, Ortega G, Cano I et al (2006) Electrochemotherapy for the local treatment of cancer. Initial experience in a surgical oncology unit in Spain and in a basic oncology unit in Nicaragua. Eur J Surg Oncol Suppl 3:61
Mir LM, Belehradek M, Domenge C et al (1991) Electrochemotherapy, a new antitumor treatment: first clinical trial. C R Acad Sci III 313:613–618
Sersa G, Miklavcic D, Cemazar M et al (2008) Electrochemotherapy in treatment of tumours. Eur J Surg Oncol 34:232–240
Rudolf Z, Stabuc B, Cemazar M et al (1995) Electrochemotherapy with bleomycin: the first clinical experience in malignant melanoma patients. Radiol Oncol 29:229–235
Heller R, Jaroszeski M, Glass L et al (1996) Phase I/II trial for the treatment of cutaneous and subcutaneous tumors using electrochemotherapy. Cancer 77:964–971
Glass L, Fenske NA, Jaroszeski M et al (1996) Bleomycin-mediated electrochemotherapy of basal cell carcinoma. J Am Acad Dermatol 34:82–86
Mir L, Glass L, Sersa G et al (1998) Effective treatment of cutaneous and subcutaneous malignant tumours by electrochemotherapy. Br J Cancer 77:2336–2342
Heller R, Jaroszeski M, Reintgen DS et al (1998) Treatment of cutaneous and subcutaneous tumors with electrochemotherapy using intralesional bleomycin. Cancer 83:148–157
Kubota Y, Mir Ll, Nakada T et al (1998) Successful treatment of metastatic skin lesions with electrochemotherapy. J Urol 160:1426
Sersa G, Stabuc B, Cemazar M et al (1998) Electrochemotherapy with cisplatin: potentiation of local cisplatin antitumour effectiveness by application of electric pulses in cancer patients. Eur J Cancer 34:1213–1218
Gehl J, Geertsen P (2000) Efficient palliation of haemorrhaging malignant melanoma skin metastases by electrochemotherapy. Melanoma Res 10:585–589
Sersa G, Stabuc B, Cemazar M et al (1998) Electrochemotherapy with cisplatin: potentiation of local cisplatin antitumour effectiveness by application of electric pulses in cancer patients. Eur J Cancer 34:1213–1218
Rols MP, Bachaud JM, Giraud P et al (2000) Electrochemotherapy of cutaneous metastases in malignant melanoma. Melanoma Res 10:468–474
Rodriguez-Cuevas S, Barroso-Bravo S, Manza-Estrada J et al (2001) Electrochemotherapy in primary and metastatic skin tumours: phase II trial using intralesional bleomycin. Arch Med Res 32:273–276
Sersa G, Cemazar M, Rudolf Z (2003) Electrochemotherapy: advantages and drawbacks in treatment of cancer patients. Cancer Ther 1:133–142
Byrne CM, Thompson JF, Jonhston H et al (2005) Treatment of metastatic melanoma using electroporation therapy with bleomycin (electrochemotherapy). Melanoma Res 15:45–51
Snoj M, Rudolf Z, Cemazar M et al (2005) Successful sphincter-saving treatment of anorectal malignant melanoma with electrochemotherapy, local excision and adjuvant brachytherapy. Anti-Cancer Drugs 16:345–349
Sersa G (2006) The state-of-the-art of electrochemotherapy before the ESOPE study; advantages and clinical uses. EJC Suppl 4:52–59
Gaudy C, Richard MA, Folchetti G et al (2006) Randomized controlled study of electrochemotherapy in the local treatment of skin metastases of melanoma. J Cutan Med Surg 10:115–121
Quaglino P, Mortera C, Osella-Abate S et al (2008) Electrochemotherapy with intravenous bleomycin in the local treatment of skin mela noma metastases. Ann Surg Oncol 15:2215–2222
Fantini F, Gualdi G, Cimitan A, Giannetti A (2008) Metastatic basal cell carcinoma with squamous differentiation: report of a case with response of cutaneous metastases to electrochemotherapy. Arch Dermatol 144:1186–1188
McBain C, Young E, Swindel R et al (2003) Local recurrence of breast cancer following surgery and radiotherapy: incidence and outcome. Clin Oncol 15:25–31
Meier F, Will S, Ellwanger U et al (2002) Metastasis pathways and time course in the orderly progression of cutaneous melanoma. Br J Dermatol 147:62–70
Zheng M, Feng B, Li J et al (2005) Effects and possible anti-tumor immunity of electrochemotherapy with bleomycin on human colon cancer xenografts in nude mice. World J Gastroenterol 11:2426–2430
Serja G, Jarm T, Kotnik T et al (2008) Vascular disrupting action of electroporation and electrochemotherapy with bleomycin in murine sarcoma. Br J Cancer 98:388–398
Gehl J, Skovsgaard T, Mir LM (2002) Vascular reactions to in vivo electroporation: characterization and consequences for drug and gene delivery. Biochim Biophys Acta 1569:51–58
Tassinari J, Orlandino G, Ardito R, Fabrizio T (2008) Electrochemotherapy in oncology reconstructive surgery: five cases preliminary report. Riv Ital Chir Plastica 55:55–59
Sloan F, Gelband H (2007) Cancer control opportunities in low- and middle-income countries. Institute of Medicine, The National Academies Press, Washington, DC
Colombo L, Di Matteo S, Mir Ll (2008) Costeffectiveness analysis of electrochemotherapy with the Cliniporator™ vs other methods for the control and treatment of cutaneous and subcutaneous tumors. Therap Clin Risk Manag 4: 1–8
Muñoz V, Barea I, Ortega G, Cabañas L (2008) The role of electrochemotherapy in local relapse of breast cancer treatment. Eur J Surg Oncol 34: 1005
Elias D (2005) Rationels de la chirugie oncologique au sein d’un traitement multodal des cancers. J Chir 142:284–289
Gehl J, Matthiessen L, Humphreys A et al (2010) Management of cutaneous metastases by electrochemotherapy J Clin Oncol 28:7s (Suppl ASCO Annual Meeting 2010 abstr 8579)
García Güal C (2000) Introducción a los tratados Hipocráticos. Gredos, Madrid
Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247
Snoj M, Cemazar M, Srnovrsnik T et al (2009) Limb sparing treatment of bleeding melanoma recurrence by electrochemotherapy. Tumori 95:398–402
Curatolo P, Mancini M, Ruggiero A et al (2008) Successful treatment of penile Kaposi’s sarcoma with electrochemotherapy. Dermatol Surg 34:1–5
Gualdi G, Monari P, Fautin F et al (2010) Electrochemotherapy-induced virus disappearance in HHV-8-positive skin nodules of Kaposi sarcoma: first histological and immunohistochemical demonstration of efficacy. J Eur Acad Dermatol Venereol 24:239–241
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Both members of GEDEOM (Grupo Español para el Estudio de la Enfermedad Oncológica y Malformativa en países emergentes)
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Muñoz Madero, V., Ortega Pérez, G. Electrochemotherapy for treatment of skin and soft tissue tumours. Update and definition of its role in multimodal therapy. Clin Transl Oncol 13, 18–24 (2011). https://doi.org/10.1007/s12094-011-0612-2
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DOI: https://doi.org/10.1007/s12094-011-0612-2