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de Caro A, Talmont F, Rols MP, Golzio M, Kolosnjaj-Tabi J. Therapeutic perspectives of high pulse repetition rate electroporation. Bioelectrochemistry 2024; 156:108629. [PMID: 38159429 DOI: 10.1016/j.bioelechem.2023.108629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
Electroporation, a technique that uses electrical pulses to temporarily or permanently destabilize cell membranes, is increasingly used in cancer treatment, gene therapy, and cardiac tissue ablation. Although the technique is efficient, patients report discomfort and pain. Current strategies that aim to minimize pain and muscle contraction rely on the use of pharmacological agents. Nevertheless, technical improvements might be a valuable tool to minimize adverse events, which occur during the application of standard electroporation protocols. One recent technological strategy involves the use of high pulse repetition rate. The emerging technique, also referred as "high frequency" electroporation, employs short (micro to nanosecond) mono or bipolar pulses at repetition rate ranging from a few kHz to a few MHz. This review provides an overview of the historical background of electric field use and its development in therapies over time. With the aim to understand the rationale for novel electroporation protocols development, we briefly describe the physiological background of neuromuscular stimulation and pain caused by exposure to pulsed electric fields. Then, we summarize the current knowledge on electroporation protocols based on high pulse repetition rates. The advantages and limitations of these protocols are described from the perspective of their therapeutic application.
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Affiliation(s)
- Alexia de Caro
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Franck Talmont
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Marie-Pierre Rols
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Muriel Golzio
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France.
| | - Jelena Kolosnjaj-Tabi
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France.
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Di Prata C, Mascherini M, Ross AM, Silvestri B, Kis E, Odili J, Fabrizio T, Jones RP, Kunte C, Orlando A, Clover J, Kumar S, Russano F, Matteucci P, Muir T, Terlizzi FD, Gehl J, Grischke EM. Efficacy of Electrochemotherapy in Breast Cancer Patients of Different Receptor Status: The INSPECT Experience. Cancers (Basel) 2023; 15:3116. [PMID: 37370726 DOI: 10.3390/cancers15123116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Electrochemotherapy has been proven to be an efficient treatment for cutaneous metastases of various cancers. Data on breast cancer (BC) patients with cutaneous metastases were retrieved from the INSPECT database. Patients were divided by their receptor status: HER2+, HR+ (ER/PgR+), and TN (triple negative). Groups were similar for histological subtype and location of the nodules. Most patients were previously treated with surgery/systemic therapy/radiotherapy. We found no differences in the three groups in terms of response ratio (OR per patient 86% HER2+, 80% HR+, 76% TN, p = 0.8664). The only factor positively affecting the complete response rate in all groups was small tumor size (<3 cm, p = 0.0105, p = 0.0001, p = 0.0266, respectively). Local progression-free survival was positively impacted by the achievement of complete response in HER2+ (p = 0.0297) and HR+ (p = 0.0094), while overall survival was affected by time to local progression in all groups (p = 0.0065 in HER2+, p < 0.0001 in HR+, p = 0.0363 in TN). ECT treatment is equally effective among groups, despite different receptor status. Response and local tumor control seem to be better in multiple small lesions than in big armor-like lesions, suggesting that treating smaller, even multiple, lesions at the time of occurrence is more effective than treating bigger long-lasting armor-like cutaneous lesions.
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Affiliation(s)
- Claudia Di Prata
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35128 Padua, Italy
| | - Matteo Mascherini
- Department of Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | | | - Barbara Silvestri
- Oncology and Haematology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima-Mirano, 30035 Venice, Italy
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, H-6720 Szeged, Hungary
| | - Joy Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Trust, London SW17 0QT, UK
| | - Tommaso Fabrizio
- Unit of Plastic Surgery, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy
| | - Rowan Pritchard Jones
- Department of Plastic Surgery, Edge Hill University, Ormskirk L39 4QP, UK
- Department of Plastic Surgery, University of Liverpool, Liverpool L7 8TX, UK
| | - Christian Kunte
- Abteilung für Dermatochirurgie und Dermatologie, Artemed Fachklinik München, 80336 Munich, Germany
| | - Antonio Orlando
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - James Clover
- Department of Plastic Surgery, Cork University Hospital, T12 DC4A Cork, Ireland
- Cancer Reseach@UCC, University College Cork, T12 YN60 Cork, Ireland
| | - Siva Kumar
- Department of Plastic Surgery, Queen Victoria Hospital National Health Service (NHS) Foundation Trust, East Grinstead RH19 3DZ, UK
| | - Francesco Russano
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Paolo Matteucci
- Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK
| | - Tobian Muir
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | | | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Eva-Maria Grischke
- Department of Gynecology, University Hospital of Tübingen, 72076 Tübingen, Germany
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Huang W, Li Z, Kang Y, Ye X, Feng W. Drug Repositioning Based on the Enhanced Message Passing and Hypergraph Convolutional Networks. Biomolecules 2022; 12:1666. [PMID: 36359016 PMCID: PMC9687543 DOI: 10.3390/biom12111666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 10/17/2023] Open
Abstract
Drug repositioning, an important method of drug development, is utilized to discover investigational drugs beyond the originally approved indications, expand the application scope of drugs, and reduce the cost of drug development. With the emergence of increasingly drug-disease-related biological networks, the challenge still remains to effectively fuse biological entity data and accurately achieve drug-disease repositioning. This paper proposes a new drug repositioning method named EMPHCN based on enhanced message passing and hypergraph convolutional networks (HGCN). It firstly constructs the homogeneous multi-view information with multiple drug similarity features and then extracts the intra-domain embedding of drugs through the combination of HGCN and channel attention mechanism. Secondly, inter-domain information of known drug-disease associations is extracted by graph convolutional networks combining node and edge embedding (NEEGCN), and a heterogeneous network composed of drugs, proteins and diseases is built as an important auxiliary to enhance the inter-domain message passing of drugs and diseases. Besides, the intra-domain embedding of diseases is also extracted through HGCN. Ultimately, intra-domain and inter-domain embeddings of drugs and diseases are integrated as the final embedding for calculating the drug-disease correlation matrix. Through 10-fold cross-validation on some benchmark datasets, we find that the AUPR of EMPHCN reaches 0.593 (T1) and 0.526 (T2), respectively, and the AUC achieves 0.887 (T1) and 0.961 (T2) respectively, which shows that EMPHCN has an advantage over other state-of-the-art prediction methods. Concerning the new disease association prediction, the AUC of EMPHCN through the five-fold cross-validation reaches 0.806 (T1) and 0.845 (T2), which are 4.3% (T1) and 4.0% (T2) higher than the second best existing methods, respectively. In the case study, EMPHCN also achieves satisfactory results in real drug repositioning for breast carcinoma and Parkinson's disease.
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Affiliation(s)
- Weihong Huang
- School of Informatics Science and Technology, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Zhong Li
- School of Informatics Science and Technology, Zhejiang Sci-Tech University, Hangzhou 310018, China
- Zhejiang Province Key Laboratory of Smart Management & Application of Modern Agricultural Resources, School of Information Engineering, Huzhou University, Huzhou 313000, China
| | - Yanlei Kang
- Zhejiang Province Key Laboratory of Smart Management & Application of Modern Agricultural Resources, School of Information Engineering, Huzhou University, Huzhou 313000, China
| | - Xinghuo Ye
- Zhejiang Province Key Laboratory of Smart Management & Application of Modern Agricultural Resources, School of Information Engineering, Huzhou University, Huzhou 313000, China
| | - Wenming Feng
- Department of General Surgery, The First Affiliated Hospital of Huzhou University, Huzhou 313000, China
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Bastrup FA, Vissing M, Gehl J. Electrochemotherapy with intravenous bleomycin for patients with cutaneous malignancies, across tumour histology: a systematic review. Acta Oncol 2022; 61:1093-1104. [DOI: 10.1080/0284186x.2022.2110385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Freya A. Bastrup
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mille Vissing
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Gehl
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Electrochemotherapy for solid tumors: literature review and presentation of a novel endoscopic approach. Radiol Oncol 2022; 56:285-291. [PMID: 35776844 PMCID: PMC9400449 DOI: 10.2478/raon-2022-0022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/13/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Electrochemotherapy (ECT) is a minimally invasive and safe treatment gaining positive and long-lasting antitumoral results that are receiving the attention of the scientific community. It is a local treatment that combines the use of electroporation and the administration of cytotoxic drugs to induce cell death in the target tissue. ECT is largely used for the treatment of cutaneous and subcutaneous lesions, and good results have been reported for the treatment of deep visceral tumors. The latest literature review is provided. Moreover, in line with its development for the treatment of visceral tumors in this article, we describe a novel approach of ECT: endoscopic treatment of colorectal cancer. Endoscopic ECT application was combined with systemic chemotherapy in the treatment of obstructing rectal cancer without prospective surgery. A good response after ECT was described: concentric involvement of the rectum was reduced, and no stenosing lesions were detected. CONCLUSIONS Clinical studies have demonstrated that ECT is a very effective treatment for tumors of different histologic types and localizations. Endoscopic treatment for gastrointestinal cancer is an innovative application of ECT. The combination of systemic treatment and ECT was safe and highly effective in the treatment of colorectal cancer, especially when obstructive, giving the patient a significant gain in quality of life.
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Campana LG, Balestrieri N, Menin N. Adjuvant skin-sparing electrochemotherapy in a breast cancer patient with a prosthetic implant: 5-year follow-up outcomes. J Surg Case Rep 2022; 2022:rjac199. [PMID: 35599994 PMCID: PMC9116585 DOI: 10.1093/jscr/rjac199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/16/2022] [Indexed: 11/14/2022] Open
Abstract
A 55-year-old woman with previous skin-sparing mastectomy and prosthetic reconstruction for multifocal ductal carcinoma developed homolateral axillary recurrence. Following nodal dissection, partial periprosthetic capsulectomy and the overlying breast skin excision, the pathology report revealed a positive cutaneous margin. Since further breast skin excision or radiotherapy would have compromised the prosthetic implant, and the patient was adamant about avoiding any endangering intervention, the multidisciplinary recommendation included skin-directed electrochemotherapy (ECT) in the frame of a multimodal treatment strategy. The procedure lasted 20 minutes under mild general sedation and included a bolus of intravenous bleomycin followed by local application of electric pulses using a needle electrode. The postprocedural course was uneventful, except for mild dermatologic toxicity. At 5 years, the patient is disease-free with the implant in situ. This report illustrates the proof-of-concept of adjuvant skin-sparing ECT to sterilize resection margins, preserve a breast implant and highlight procedural details to avert toxicity.
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Affiliation(s)
- Luca G Campana
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
- Department of Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Nicola Menin
- Breast Unit, ULSS 2 Marca Trevigiana, Vittorio Veneto, Italy
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Positive ROS (Reactive Oxygen Species) Modulator Engineered Device Support Skin Treatment in Locally Advanced Breast Cancer (LABC) Enhancing Patient Quality of Life. J Clin Med 2021; 11:jcm11010126. [PMID: 35011865 PMCID: PMC8745501 DOI: 10.3390/jcm11010126] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/11/2022] Open
Abstract
The development of research in genetic and biochemical fields has made it possible to investigate certain metabolic aspects of the microenvironment of chronic skin lesions, including altered cell signalling, highlighting its importance in determining the blockage of repair processes. The purpose of this prospective observational study is to evaluate the efficacy of a medical device consisting of a polyester scaffold enriched with an oleic matrix with controlled release of ROS in the management of LABC skin lesions. During the period from October 2018 to March 2020, 20 patients with locally advanced breast cancer were enrolled and ten were treated with the devices abovementioned. After 30 days of treatment all patients treated reported a general improvement in local conditions with reduction in ulceration area, exudate and odour. The results suggest that the application of these devices even in particular conditions (healthy and neoplastic tissue) does not lead to the onset of negative effects due to the release of ROS, though their role in tissue repair requires further study to fully understand their potential and increase the fields of application of the device by exploiting its modulation capabilities.
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8
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The electrical pulse application enhances intra-cellular localization and potentiates cytotoxicity of curcumin in breast cancer cells. Bioelectrochemistry 2021; 140:107817. [PMID: 33940353 DOI: 10.1016/j.bioelechem.2021.107817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 12/24/2022]
Abstract
Breast cancer is the most common cancer of women, and fifth leading cause of mortality worldwide. Existing breast cancer regimens are costly and produce severe side effects. This highlights a need for the development of efficient novel therapies, which are cost effective and limit side effects. An electrical pulse (EP)-based chemo therapy, known as electrochemotherapy (ECT) using the natural compound curcumin could be an effective alternative. ECT is a non-surgical modality, which produces excellent anti-tumor efficacy at small drug concentrations due to increased uptake of drugs. In clinics, ECT is shown to be effective in treating advanced, recurrent, and metastatic breast cancers, which are refractory to multiple modalities. ECT with curcumin triggers apoptotic cell death in breast cancer cells and could be an effective alternative, due to curcumin's low cost and reduced side-effects. However, there is a lack of studies quantifying the uptake of curcumin in response to EP application. Towards this, we determined the uptake of different curcuminoids (curcumin, desmethoxycurcumin, and bisdemethoxycurcumin) upon EP application and their impact on cell cytotoxicity. Additionally, we studied the combined effect of calcium chloride (CaCl2) and a curcuminoids (Cur) mixture, based on initial studies suggesting calcium electroporation as a potential inexpensive anti-cancer treatment. Our results indicate EP with Cur increases cellular uptake, cell shrinkage, and cytotoxicity. The EP + Cur resulted in the highest uptake of the bisdemethoxycurcumin. Further, EP also potentiated the cytotoxicity of CaCl2 and of the Cur and CaCl2 combination against breast cancer cells and caused apoptosis. Our preliminary data pave the way to further studies on Cur and CaCl2 combination treating breast cancer.
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Li Y, Umbach DM, Krahn JM, Shats I, Li X, Li L. Predicting tumor response to drugs based on gene-expression biomarkers of sensitivity learned from cancer cell lines. BMC Genomics 2021; 22:272. [PMID: 33858332 PMCID: PMC8048084 DOI: 10.1186/s12864-021-07581-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/04/2021] [Indexed: 02/07/2023] Open
Abstract
Background Human cancer cell line profiling and drug sensitivity studies provide valuable information about the therapeutic potential of drugs and their possible mechanisms of action. The goal of those studies is to translate the findings from in vitro studies of cancer cell lines into in vivo therapeutic relevance and, eventually, patients’ care. Tremendous progress has been made. Results In this work, we built predictive models for 453 drugs using data on gene expression and drug sensitivity (IC50) from cancer cell lines. We identified many known drug-gene interactions and uncovered several potentially novel drug-gene associations. Importantly, we further applied these predictive models to ~ 17,000 bulk RNA-seq samples from The Cancer Genome Atlas (TCGA) and the Genotype-Tissue Expression (GTEx) database to predict drug sensitivity for both normal and tumor tissues. We created a web site for users to visualize and download our predicted data (https://manticore.niehs.nih.gov/cancerRxTissue). Using trametinib as an example, we showed that our approach can faithfully recapitulate the known tumor specificity of the drug. Conclusions We demonstrated that our approach can predict drugs that 1) are tumor-type specific; 2) elicit higher sensitivity from tumor compared to corresponding normal tissue; 3) elicit differential sensitivity across breast cancer subtypes. If validated, our prediction could have relevance for preclinical drug testing and in phase I clinical design. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-021-07581-7.
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Affiliation(s)
- Yuanyuan Li
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr., Research Triangle Park, MD A3-03, Durham, NC, 27709, USA
| | - David M Umbach
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr., Research Triangle Park, MD A3-03, Durham, NC, 27709, USA
| | - Juno M Krahn
- Genome Integrity & Structural Biology Laboratory, Research Triangle Park, Durham, NC, 27709, USA
| | - Igor Shats
- Signal Transduction Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC, 27709, USA
| | - Xiaoling Li
- Signal Transduction Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC, 27709, USA
| | - Leping Li
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr., Research Triangle Park, MD A3-03, Durham, NC, 27709, USA.
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Sersa G, Mascherini M, Di Prata C, Odili J, de Terlizzi F, McKenzie GA, Clover AJP, Bertino G, Spina R, Groselj A, Cappellesso R, Gehl J, Bisase B, Curatolo P, Kis E, Lico V, Muir T, Orlando A, Quaglino P, Matteucci P, Valpione S, Campana LG. Outcomes of older adults aged 90 and over with cutaneous malignancies after electrochemotherapy with bleomycin: A matched cohort analysis from the InspECT registry. Eur J Surg Oncol 2021; 47:902-912. [DOI: 10.1016/j.ejso.2020.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/09/2020] [Accepted: 10/30/2020] [Indexed: 12/11/2022] Open
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Electrochemotherapy Modulates Mammary Tumor Growth in Rats on a Western Diet Supplemented with Curcumin. Biomedicines 2020; 8:biomedicines8110498. [PMID: 33202747 PMCID: PMC7697715 DOI: 10.3390/biomedicines8110498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022] Open
Abstract
In the US, every 12 min, six women are diagnosed with breast cancer and one dies. This highlights a critical need for developing alternate therapies using natural compounds, which are cost effective and with less side effects. Curcumin, the yellow pigment of turmeric has been found to suppress initiation, progression, and metastasis of a variety of tumors. Multiple clinical trials highlight the efficacy of curcumin in treating breast cancer and other diseases. Our in vitro studies have demonstrated that the electrical pulse (EP) application can further enhance the effectiveness of curcumin against breast cancer cells in a therapy called electrochemotherapy (ECT). In a direct extension of these results, we studied the effect of ECT coupled with intratumoral curcumin administration (EP+Cur) on N-methyl-N-nitrosourea (MNU) induced mammary tumors in female Sprague Dawley rats. Beginning at the weaning and throughout the study, rats were fed either western diet (West) or western diet, supplemented with 1% curcumin (W+Cur). Our results showed that EP+Cur treatment led to a reduced growth rate in rats fed with W+Cur diet compared to West diet (57.14% vs. 16.67% in West diet). These results provide a foundation for further studies towards utilizing it in clinical practice.
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Ferioli M, Perrone AM, Buwenge M, Arcelli A, Zamagni A, Macchia G, Deodato F, Cilla S, Tagliaferri L, De Terlizzi F, De Iaco P, Zamagni C, Morganti AG. Electrochemotherapy of skin metastases from breast cancer: a systematic review. Clin Exp Metastasis 2020; 38:1-10. [PMID: 33180222 DOI: 10.1007/s10585-020-10063-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022]
Abstract
Skin metastases occur in 5-30% of breast cancer (BC) patients. Standard treatments include systemic therapies (chemotherapy, endocrine therapy, and immunotherapy) and local treatments (surgery and radiotherapy). Electrochemotherapy (ECT) could be another option in this setting based on preclinical and clinical studies. Aim of this review was to analyze the available evidence on ECT in skin metastases from BC. Studies reporting on ECT in skin metastases from BC were included in this review. Studies not reporting toxicity or tumor response or not reporting results separately from other primary cancers were excluded. The search was based on Medline, Scopus, and The Cochrane Library databases. Eleven studies including 464 patients were analyzed. ECT was performed using intravenous/intratumoral bleomycin (10 studies) or intratumoral cisplatin (one study). Complete and overall pooled response rates were 46.2% (95%CI 33.2-59.4 and 74.6% (95%CI 60.6-86.4) in studies reporting results on a per patient basis and 61.9% (95%CI 53.8-69.6) and 86.9% (95%CI 80.0-92.6) in studies reporting results on a per lesion basis, respectively. Worse response rates in larger lesions were observed in three studies. The incidence of toxicity was heterogeneous but adverse events were mild and manageable in all studies. One- and 3-year local progression-free survival was 86.2% and 81.0% in two studies, respectively. ECT is tolerable and effective in terms of response in BC skin metastases especially in less advanced lesions. Further studies are justified to compare ECT with other treatments in this setting.
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Affiliation(s)
- Martina Ferioli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy.
| | - Anna Myriam Perrone
- Oncologic Gynaecology Unit, Department Medical and Surgical Sciences (DIMEC), University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy
| | - Savino Cilla
- Medical Physic Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | | | - Pierandrea De Iaco
- Oncologic Gynaecology Unit, Department Medical and Surgical Sciences (DIMEC), University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Zamagni
- Department of Hematology and Oncology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
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13
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Vera-Tizatl CE, Talamás-Rohana P, Vera-Hernández A, Leija-Salas L, Rodríguez-Cuevas SA, Chávez-Munguía B, Vera-Tizatl AL. Cell morphology impact on the set-up of electroporation protocols for in-suspension and adhered breast cancer cells. Electromagn Biol Med 2020; 39:323-339. [PMID: 32762310 DOI: 10.1080/15368378.2020.1799387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In order to establish cancer-type-specific electroporation protocols for breast cancer, electroporation was performed in vitro in two modalities: in-suspension and adhered cells. Electroporation of cell suspensions was carried out through commercial electroporation cuvettes whereas a novel electrode for electroporation of adhered cells was designed and manufactured aimed to preserve cell structure, to provide a closer model to an in vivo scenario, and as a means to visualize the mechanical effects of electroporation on the cell membrane by using scanning electron microscopy. Electroporation protocols and electric field thresholds were predicted in silico and experimentally tuned through propidium iodide uptake and cell viability. Three breast-cancer cell lines (BT-20, MCF-7 and HCC1419) and a non-cancerous cell line (BEAS-2B) were used. Cancerous cells responded differently to electroporation depending on the electric parameters, cell histology, the cell culture modality, and the cell morphology (membrane thickness mainly), which was evaluated trough confocal and transmission electron microscopy. Particularly, it was found that electrochemotherapy may represent a promising alternative as an adjuvant treatment of metastatic breast tumours, and as a neoadjuvant therapy for Her2/neu tumours. Oppositely, triple negative breast tumours may show a high sensitivity to electroporation and therefore, they could be efficiently treated with irreversible electroporation. On the other hand, noncancerous cells demanded the highest voltage in both cell culture modalities in order to be electroporated. Hence, these cells in suspension may provide a reliable, easy-to-perform, low-cost model for the development of electroporation protocols for eradication of healthy tissue around a tumour in a safety margin.
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Affiliation(s)
- C E Vera-Tizatl
- Departamento De Infectómica Y Patogénesis Molecular, Centro De Investigación Y De Estudios Avanzados Del Instituto Politécnico Nacional (CINVESTAV) , Mexico City, México
| | - P Talamás-Rohana
- Departamento De Infectómica Y Patogénesis Molecular, Centro De Investigación Y De Estudios Avanzados Del Instituto Politécnico Nacional (CINVESTAV) , Mexico City, México
| | - A Vera-Hernández
- Departamento De Ingeniería Eléctrica, Centro De Investigación Y De Estudios Avanzados Del Instituto Politécnico Nacional (CINVESTAV) , Mexico City, México
| | - L Leija-Salas
- Departamento De Ingeniería Eléctrica, Centro De Investigación Y De Estudios Avanzados Del Instituto Politécnico Nacional (CINVESTAV) , Mexico City, México
| | - S A Rodríguez-Cuevas
- Scientific Research Department , Sociedad Mexicana De Oncología , Mexico City, México
| | - B Chávez-Munguía
- Departamento De Infectómica Y Patogénesis Molecular, Centro De Investigación Y De Estudios Avanzados Del Instituto Politécnico Nacional (CINVESTAV) , Mexico City, México
| | - A L Vera-Tizatl
- Departamento De Ingeniería Eléctrica, Centro De Investigación Y De Estudios Avanzados Del Instituto Politécnico Nacional (CINVESTAV) , Mexico City, México
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Wolff CM, Steuer A, Stoffels I, von Woedtke T, Weltmann KD, Bekeschus S, Kolb JF. Combination of cold plasma and pulsed electric fields – A rationale for cancer patients in palliative care. CLINICAL PLASMA MEDICINE 2019. [DOI: 10.1016/j.cpme.2020.100096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Campana LG, Miklavčič D, Bertino G, Marconato R, Valpione S, Imarisio I, Dieci MV, Granziera E, Cemazar M, Alaibac M, Sersa G. Electrochemotherapy of superficial tumors - Current status:: Basic principles, operating procedures, shared indications, and emerging applications. Semin Oncol 2019; 46:173-191. [PMID: 31122761 DOI: 10.1053/j.seminoncol.2019.04.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 12/18/2022]
Abstract
Treatment of superficial tumors with electrochemotherapy (ECT) has shown a steep rise over the past decade and indications range from skin cancers to locally advanced or metastatic neoplasms. Based on reversible electroporation, which is a physical method to achieve transient tumor cell membrane permeabilization by means of short electric pulses, ECT increases cellular uptake of bleomycin and cisplatin and their cytotoxicity by 8,000- and 80-fold, respectively. Standard operating procedures were established in 2006 and updated in 2018. Ease of administration, patient tolerability, efficacy across histotypes, and repeatability are peculiar advantages, which make standard ECT (ie, ECT using fixed-geometry electrodes) a reliable option for controlling superficial tumor growth locally and preventing their morbidity. Consolidated indications include superficial metastatic melanoma, breast cancer, head and neck skin tumors, nonmelanoma skin cancers, and Kaposi sarcoma. In well-selected patients with oropharyngeal cancers, ECT ensures appreciable symptom control. Emerging applications include skin metastases from visceral or hematological malignancies, vulvar cancer, and some noncancerous skin lesions (keloids and capillary vascular malformations). Repeatability and integration with other oncologic therapies allow for consolidation of response and sustained tumor control. In this review, we present the basic principles of ECT, recently updated operating procedures, anesthesiological management, and provide a synthesis of the efficacy of standard ECT across histotypes.
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Affiliation(s)
- Luca G Campana
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy; Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
| | - Damijan Miklavčič
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | | | - Ilaria Imarisio
- Medical Oncology Unit, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Maria Vittoria Dieci
- Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; Medical Oncology-2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Elisa Granziera
- Anesthesiology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Mauro Alaibac
- Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Vera-Tizatl AL, Vera-Tizatl CE, Vera-Hernández A, Leija-Salas L, Rodríguez S, Miklavčič D, Kos B. Computational Feasibility Analysis of Electrochemotherapy With Novel Needle-Electrode Arrays for the Treatment of Invasive Breast Ductal Carcinoma. Technol Cancer Res Treat 2019; 17:1533033818794939. [PMID: 30157721 PMCID: PMC6116067 DOI: 10.1177/1533033818794939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Breast cancer represents a rising problem concerning public health worldwide. Current efforts are aimed to the development of new minimally invasive and conservative treatment procedures for this disease. A treatment approach for invasive breast ductal carcinoma could be based on electroporation. Hence, in order to determine the effectiveness of electrochemotherapy in the treatment of this disease, 12 electrode models were investigated on realistic patient-specific computational breast models of 3 patients diagnosed by Digital Breast Tomosynthesis imaging. The electrode models exhibit 4, 5, and 6 needles arranged in 4 geometric configurations (delta, diamond, and star) and 3 different needle spacing resulting in a total of 12 needle-electrode arrays. Electric field distribution in the tumors and a surrounding safety margin of 1 cm around the tumor edge is computed using the finite element method. Efficiency of the electrode arrays was determined hierarchically based on (1) percentage of tumor volume reversibly electroporated, (2) percentage of tumor volume irreversibly electroporated, (3) percentage of treated safety margin volume, (4) minimal invasiveness, that is, minimal number of electrodes used, (5) minimal activated electrode pairs, and (6) minimal electric current. Results show that 3 electrode arrays (4 needle-delta, 5 needle-diamond, and 6 needle-star) with fixed-geometry configuration could be used in the treatment with electrochemotherapy of invasive breast ductal carcinomas ranging from 1 to 5 cm3 along with a surrounding safety margin of 1 cm.
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Affiliation(s)
- Adriana Leticia Vera-Tizatl
- 1 Department of Electrical Engineering, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City, Mexico
| | - Claudia Elizabeth Vera-Tizatl
- 2 Department of Infectomics and Molecular Pathogenesis, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City, Mexico
| | - Arturo Vera-Hernández
- 1 Department of Electrical Engineering, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City, Mexico
| | - Lorenzo Leija-Salas
- 1 Department of Electrical Engineering, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City, Mexico
| | | | - Damijan Miklavčič
- 4 Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Bor Kos
- 4 Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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Matthiessen LW, Keshtgar M, Curatolo P, Kunte C, Grischke EM, Odili J, Muir T, Mowatt D, Clover JP, Liew SH, Dahlstroem K, Newby J, Letulé V, Stauss E, Humphreys A, Banerjee S, Klein A, Rotunno R, de Terlizzi F, Gehl J. Electrochemotherapy for Breast Cancer—Results From the INSPECT Database. Clin Breast Cancer 2018; 18:e909-e917. [DOI: 10.1016/j.clbc.2018.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 12/21/2022]
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Wichtowski M, Murawa D, Kulcenty K, Zaleska K. Electrochemotherapy in Breast Cancer - Discussion of the Method and Literature Review. Breast Care (Basel) 2017; 12:409-414. [PMID: 29456474 DOI: 10.1159/000479954] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Breast cancer is the most common cause of skin metastases in women. The probability of their occurrence ranges from about 5% in the entire population to as much as 30% in the late stages of the disease. Although rarely life-threatening, they have a major impact on the quality of life of patients with this diagnosis, being the cause of pain, effusion, ulceration, infection, and psychological discomfort. Available methods of treatment, both local and systemic, often fail to provide adequate control of the disease. A particular challenge seems to be the treatment of those patients with cutaneous metastases who, due to the extent of their metastases, are not eligible for resection, in whom the possibility of radiation therapy has already been used, and in whom systemic therapy is ineffective or contraindicated. A new method providing the opportunity for effective treatment is electrochemotherapy (ECT). ECT combines electropulsation of tumor cells (by local application of electric pulses) and administration of antineoplastic drugs such as cisplatin or bleomycin (either intravenous or intratumoral). Several clinical studies have demonstrated that ECT provides safe, efficient, and non-invasive locoregional treatment for chest wall breast cancer recurrence.
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Affiliation(s)
- Mateusz Wichtowski
- Oncological and General Surgery Ward I, Greater Poland Cancer Center, Poznan, Poland
| | - Dawid Murawa
- Department of General and Minimally Invasive Surgery, Poland Baptism Monument Hospital, Gniezno, Poland
| | | | - Karolina Zaleska
- Radiobiology Laboratory, Greater Poland Cancer Centre, Poznan, Poland
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Plaschke CC, Bertino G, McCaul JA, Grau JJ, de Bree R, Sersa G, Occhini A, Groselj A, Langdon C, Heuveling DA, Cemazar M, Strojan P, Leemans CR, Benazzo M, De Terlizzi F, Wessel I, Gehl J. European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project: Results from the treatment of mucosal cancers. Eur J Cancer 2017; 87:172-181. [DOI: 10.1016/j.ejca.2017.10.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/04/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022]
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Grischke EM, Röhm C, Stauß E, Taran FA, Brucker SY, Wallwiener D. Electrochemotherapy - Supplementary Treatment for Loco-regional Metastasized Breast Carcinoma Administered to Concomitant Systemic Therapy. Radiol Oncol 2017; 51:317-323. [PMID: 28959168 PMCID: PMC5611996 DOI: 10.1515/raon-2017-0027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/18/2017] [Indexed: 12/21/2022] Open
Abstract
Background Electrochemotherapy (ECT) is an established procedure for treating breast cancer loco-regional recurrences following surgical intervention and/or radiotherapy. Limited information is available on ECT application as a concomitant procedure to systemic therapy in recurrent breast cancer. The primary objective of this study was to determine if the application of ECT in close temporal relation to systemic chemotherapy could lead to increased local and/or systemic side effects. For this purpose we evaluated the safety of ECT as a supplemental local therapy to systemic therapy. ECT local and systemic toxicity and side effects were recorded and whether the anticipated local therapeutic effect of ECT would be influenced by the concomitant use of systemic therapies was investigated. Patients and methods This is an observational study. Thirty three patients with loco-regional metastasized breast carcinoma were treated and observed over a period of three years with 46 ECT applications for local tumour control in addition to established systemic therapy. A specific timeline for ECT administration was not fixed up, but was generally performed one week before the following chemotherapy administration with the aim to avoid the so called nadir, this means the peak period with risk of neutropenia. Results Data was collected over a period of three years on a population of 33 metastatic patients. Fifteen patients, received neo-adjuvant therapy as part of their primary treatment, but still had an advanced stage tumour. Some patients received repeated ECT applications. Objective tumour response was observed in 90% of the treated patients. Patients showed no increased local toxicity, especially no higher dermal toxicity, e.g. formation of local necrosis. Conclusions ECT proved to be an effective supplement to a cytotoxic systemic therapy, especially for high-risk patients who did not respond well to systemic therapy of loco-regional metastases, without creating any greater systemic or loco-regional toxicities.
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Affiliation(s)
- Eva-Maria Grischke
- Prof. Eva-Maria Grischke, M.D., Department of Gynecology, University Hospital Tübingen, Tübingen, Germany E-mail:
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Effective treatment of intractable cutaneous metastases of breast cancer with electrochemotherapy: a useful contributor to cutaneous disease control. Breast Cancer Res Treat 2017; 163:403-405. [DOI: 10.1007/s10549-017-4187-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
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Treatment of cutaneous metastases of breast cancer with electrochemotherapy: what is the magnitude of clinical benefit? Breast Cancer Res Treat 2017; 163:399-401. [DOI: 10.1007/s10549-017-4186-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/03/2017] [Indexed: 12/21/2022]
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Campana LG, Matthiessen LW, Snoj M, Sersa G. Electrochemotherapy of Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The Effect of Millisecond Pulsed Electric Fields (msPEF) on Intracellular Drug Transport with Negatively Charged Large Nanocarriers Made of Solid Lipid Nanoparticles (SLN): In Vitro Study. J Membr Biol 2016; 249:645-661. [PMID: 27173678 PMCID: PMC5045845 DOI: 10.1007/s00232-016-9906-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/02/2016] [Indexed: 12/21/2022]
Abstract
Drug delivery technology is still a dynamically developing field of medicine. The main direction in nanotechnology research (nanocarriers, nanovehicles, etc.) is efficient drug delivery to target cells with simultaneous drug reduction concentration. However, nanotechnology trends in reducing the carrier sizes to several nanometers limit the volume of the loaded substance and may pose a danger of uncontrolled access into the cells. On the other hand, nanoparticles larger than 200 nm in diameter have difficulties to undergo rapid diffusional transport through cell membranes. The main advantage of large nanoparticles is higher drug encapsulation efficiency and the ability to deliver a wider array of drugs. Our present study contributes a new approach with large Tween 80 solid lipid nanoparticles SLN (i.e., hydrodynamic GM-SLN-glycerol monostearate, GM, as the lipid and ATO5-SLNs-glyceryl palmitostearate, ATO5, as the lipid) with diameters DH of 379.4 nm and 547 nm, respectively. They are used as drug carriers alone and in combination with electroporation (EP) induced by millisecond pulsed electric fields. We evaluate if EP can support the transport of large nanocarriers into cells. The study was performed with two cell lines: human colon adenocarcinoma LoVo and hamster ovarian fibroblastoid CHO-K1 with coumarin 6 (C6) as a fluorescent marker for encapsulation. The biological safety of the potential treatment procedure was evaluated with cell viability after their exposure to nanoparticles and EP. The EP efficacy was evaluated by FACS method. The impact on intracellular structure organization of cytoskeleton was visualized by CLSM method with alpha-actin and beta-tubulin. The obtained results indicate low cytotoxicity of both carrier types, free and loaded with C6. The evaluation of cytoskeleton proteins indicated no intracellular structure damage. The intracellular uptake and accumulation show that SLNs do not support transport of C6 coumarin. Only application of electroporation improved the transport of encapsulated and free C6 into both treated cell lines.
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Campana LG, Clover AJP, Valpione S, Quaglino P, Gehl J, Kunte C, Snoj M, Cemazar M, Rossi CR, Miklavcic D, Sersa G. Recommendations for improving the quality of reporting clinical electrochemotherapy studies based on qualitative systematic review. Radiol Oncol 2016; 50:1-13. [PMID: 27069444 PMCID: PMC4825335 DOI: 10.1515/raon-2016-0006] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/11/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Electrochemotherapy is becoming a well-established treatment for malignancies of skin and non-skin origin and its use is widening across Europe. The technique was developed and optimized from solid experimental and clinical evidence. A consensus document is now warranted to formalize reporting results, which should strengthen evidence-based practice recommendations. This consensus should be derived from high quality clinical data collection, clinical expertise and summarizing patient feedback. The first step, which is addressed in this paper, aims to critically analyze the quality of published studies and to provide the recommendations for reporting clinical trials on electrochemotherapy. METHODS The quality of reporting in published studies on electrochemotherapy was analyzed in order to produce procedure specific reporting recommendations. A comprehensive literature search of studies published from 2006 to 2015 was performed followed by qualitative analysis of manuscripts assessing for 47 quality criteria grouped into four major clusters: (1) trial design, (2) description of patient population, (3) description of treatment delivery and patient outcome, (4) analysis of results and their interpretation. The summary measure during literature assessment was the proportion of studies fulfilling each manuscript quality criteria. RESULTS A total of 56 studies were screened, from the period 2006 to 2015, of which 33 were included in the qualitative analysis, with a total of 1215 patients. Overall, the quality of reporting was highly variable. Twenty-four reports (73%) were single-center, non-comparative studies, and only 15 (45%) were prospective in nature (only 2 of them were entered into a clinical trials registry). Electrochemotherapy technique was consistently reported, with most studies (31/33) adhering closely to published standard operating procedures. The quality of reporting the patient population was variable among the analyzed studies, with only between 45% and 100% achieving dedicated quality criteria. Reporting of treatment delivery and patient outcome was also highly variable with studies only fulfilling between 3% and 100%. Finally, reporting study results critically varied, fulfilling from 27% to 100% of the quality criteria. Based on the critical issues emerging from this analysis, recommendations and minimal requirements for reporting clinical data on electrochemotherapy were prepared and summarized into a checklist. CONCLUSIONS There is an increasing body of published clinical data on electrochemotherapy, but more high quality clinical data are needed. Published papers often lack accurate description of study population, treatment delivery as well as patient outcome. Our recommendations, provided in the form of a summary checklist, are intended to ameliorate data reporting in future studies on electrochemotherapy and help researchers to provide a solid evidence basis for clinical practice.
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Affiliation(s)
| | - A. James P. Clover
- Department of Plastic Surgery, Cork University Hospital and Cork Cancer Research Centre, University College Cork, Cork, Ireland
| | | | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Torino, Torino, Italy
| | - Julie Gehl
- Center for Experimental Drug and Gene Electro transfer, Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Christian Kunte
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Munich, Germany
| | | | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Damijan Miklavcic
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Kulbacka J. Nanosecond pulsed electric fields (nsPEFs) impact and enhanced Photofrin II® delivery in photodynamic reaction in cancer and normal cells. Photodiagnosis Photodyn Ther 2015; 12:621-9. [DOI: 10.1016/j.pdpdt.2015.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/14/2015] [Accepted: 11/05/2015] [Indexed: 02/07/2023]
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Cabula C, Campana LG, Grilz G, Galuppo S, Bussone R, De Meo L, Bonadies A, Curatolo P, De Laurentiis M, Renne M, Valpione S, Fabrizio T, Solari N, Guida M, Santoriello A, D'Aiuto M, Agresti R. Electrochemotherapy in the Treatment of Cutaneous Metastases from Breast Cancer: A Multicenter Cohort Analysis. Ann Surg Oncol 2015; 22 Suppl 3:S442-50. [PMID: 26242370 PMCID: PMC4686551 DOI: 10.1245/s10434-015-4779-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Indexed: 12/25/2022]
Abstract
Background The management of breast cancer (BC) skin metastases represents a therapeutic challenge. Electrochemotherapy (ECT) combines the administration of bleomycin with temporary permeabilization induced by locally administered electric pulses. Preliminary experience with ECT in BC patients is encouraging. Methods A total of 125 patients with BC skin metastases who underwent ECT between 2010 and 2013 were enrolled onto a multicenter retrospective cohort study. The treatment was administered following the European Standard Operative Procedures of Electrochemotherapy. Tumor response was clinically assessed adapting the Response Evaluation Criteria in Solid Tumors, and toxicity was evaluated according to Common Terminology Criteria for Adverse Events 4.0. Cox regression analysis was used to identify predictive factors. Results Response was evaluable in 113 patients for 214 tumors (median 1 per patient, range 1–3). The overall response rate after 2 months was 90.2 %, while the complete response (CR) rate was 58.4 %. In multivariate analysis, small tumor size (P < 0.001), absence of visceral metastases (P = 0.001), estrogen receptor positivity (P = 0.016), and low Ki-67 index (P = 0.024) were significantly associated with CR. In the first 48 h, 10.4 % of patients reported severe skin pain. Dermatologic toxicity included grade 3 skin ulceration (8.0 %) and grade 2 skin hyperpigmentation (8.8 %). Tumor 1-year local progression-free survival was 86.2 % (95 % confidence interval 79.3–93.8) and 96.4 % (95 % confidence interval 91.6–100) in the subgroup of those with CR. Conclusions In this study, small tumor size, absence of visceral metastases, estrogen receptor positivity, and low Ki-67 index were predictors of CR after ECT. Patients who experienced CR had durable local control. ECT represents a valuable skin-directed therapy for selected patients with BC.
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Affiliation(s)
- C Cabula
- Oncologic Surgery, Ospedale Oncologico A. Businco, Cagliari, Italy
| | - L G Campana
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - G Grilz
- Breast Surgery Unit, Ospedale Le Molinette, Turin, Italy
| | - S Galuppo
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - R Bussone
- Breast Surgery Unit, Ospedale Le Molinette, Turin, Italy
| | - L De Meo
- Humanitas-Centro Catanese di Oncologia, Catania, Italy
| | - A Bonadies
- Plastic Surgery Unit, San Gallicano Dermatologic Institute, Rome, Italy
| | - P Curatolo
- Dermatology and Plastic Surgery Department, La Sapienza University, Rome, Italy
| | | | - M Renne
- Fondazione T. Campanella, Catanzaro, Italy
| | - S Valpione
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - T Fabrizio
- Plastic Surgery Unit, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | - N Solari
- Surgical Unit 1, IRCCS San Martino-IST, Genoa, Italy
| | - M Guida
- Medical Oncology Unit, Istituto dei Tumori, Bari, Italy
| | - A Santoriello
- Department of Medicine and Surgery, "Federico II" University, Naples, Italy
| | - M D'Aiuto
- Breast Surgery Unit, Istituto Nazionale Tumori "Pascale", Naples, Italy
| | - R Agresti
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Mir-Bonafé J, Vilalta A, Alarcón I, Carrera C, Puig S, Malvehy J, Rull R, Bennàssar A. Electrochemotherapy in the Treatment of Melanoma Skin Metastases: A Report on 31 Cases. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.adengl.2015.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Quaglino P, Matthiessen LW, Curatolo P, Muir T, Bertino G, Kunte C, Odili J, Rotunno R, Humphreys AC, Letulé V, Marenco F, Cuthbert C, Albret R, Benazzo M, De Terlizzi F, Gehl J. Predicting patients at risk for pain associated with electrochemotherapy. Acta Oncol 2015; 54:298-306. [PMID: 25591818 DOI: 10.3109/0284186x.2014.992546] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Electrochemotherapy describes the use of electric pulses to enhance chemotherapy uptake, and has proven highly efficient in treating cutaneous metastases. Patients referred for electrochemotherapy present with diverse clinical pictures, from multiple small lesions to large, ulcerated lesions. Post-electrochemotherapy pain has been observed in some patients. The objectives of this study were to evaluate pain scores before and after electrochemotherapy, and to investigate if patients at risk of post-procedure pain could be identified. METHODS Seven cancer centres in the International Network for Sharing Practices on Electrochemotherapy (INSPECT) consecutively and prospectively reported to a common database. Electrochemotherapy consisted of intratumoural or intravenous injection of bleomycin, followed by delivery of electric pulses in local or general anesthesia. RESULTS Of 121 patients 39% had metastatic melanoma, 18% squamous cell carcinoma, 16% breast cancer, 13% basal-cell carcinoma, and 14% other malignancies. Median size of the largest nodules was 2.3 cm (range 0.3-40 cm). A majority of patients presented with low pain scores, and this continued through follow-up (74%). A subset of patients had moderate (13%) or severe pain (13%) after treatment. Post-procedure pain was statistically significantly associated with: 1) moderate or severe pain before treatment (p<0.0001); 2) size of the largest treated lesion (p<0.01); 3) previous irradiation (p<0.02); and 4) high treatment current value (p<0.0001). CONCLUSION The majority of patients had no or mild pain after electrochemotherapy. Patients at risk for post-procedure pain could be identified at the pre-treatment visit, and/or at the time of treatment, enabling a pain management strategy for this group.
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Affiliation(s)
- Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Torino , Torino , Italy
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Electrochemotherapy in the treatment of melanoma skin metastases: a report on 31 cases. ACTAS DERMO-SIFILIOGRAFICAS 2014; 106:285-91. [PMID: 25512237 DOI: 10.1016/j.ad.2014.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 10/08/2014] [Accepted: 10/18/2014] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Electrochemotherapy is indicated for the treatment of unresectable cutaneous and subcutaneous tumors. The technique involves the synergistic use of electroporation of cell membranes to increase the cytotoxicity of anticancer drugs delivered to the tumor cells. The aim of this study was to analyze the clinical effectiveness and safety of electrochemotherapy in the treatment of unresectable locoregional recurrent or metastatic melanomas. MATERIAL AND METHODS We studied 31 patients treated between January 2007 and December 2012. The European Standard Operating Procedures of Electrochemotherapy (ESOPE) were applied in all cases. Treatment response was analyzed as overall patient response (mean response based on results for all lesions treated in a given patient). RESULTS Response was classified as partial in 49% of patients and complete in 23%. At 1 year, the level of response achieved had been maintained in 17 patients. Disease progression was observed in 28% of the series. Immediate local complications (pain, swelling, erythema) were mild and resolved within 48hours in most cases. Eight patients developed subsequent local complications, such as ulcers and secondary infections associated with necrosis of the lesions. These complications were brought under control with topical treatments. CONCLUSIONS Electrochemotherapy is a very effective, safe, and efficient treatment for advanced locoregional disease in patients with unresectable melanoma lesions.
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