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Morozas A, Malyško-Ptašinskė V, Kulbacka J, Ivaška J, Ivaškienė T, Novickij V. Electrochemotherapy for head and neck cancers: possibilities and limitations. Front Oncol 2024; 14:1353800. [PMID: 38434679 PMCID: PMC10905418 DOI: 10.3389/fonc.2024.1353800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Head and neck cancer continues to be among the most prevalent types of cancer globally, yet it can be managed with appropriate treatment approaches. Presently, chemotherapy and radiotherapy stand as the primary treatment modalities for various groups and regions affected by head and neck cancer. Nonetheless, these treatments are linked to adverse side effects in patients. Moreover, due to tumor resistance to multiple drugs (both intrinsic and extrinsic) and radiotherapy, along with numerous other factors, recurrences or metastases often occur. Electrochemotherapy (ECT) emerges as a clinically proven alternative that offers high efficacy, localized effect, and diminished negative factors. Electrochemotherapy involves the treatment of solid tumors by combining a non-permeable cytotoxic drug, such as bleomycin, with a locally administered pulsed electric field (PEF). It is crucial to employ this method effectively by utilizing optimal PEF protocols and drugs at concentrations that do not possess inherent cytotoxic properties. This review emphasizes an examination of diverse clinical practices of ECT concerning head and neck cancer. It specifically delves into the treatment procedure, the choice of anti-cancer drugs, pre-treatment planning, PEF protocols, and electroporation electrodes as well as the efficacy of tumor response to the treatment and encountered obstacles. We have also highlighted the significance of assessing the spatial electric field distribution in both tumor and adjacent tissues prior to treatment as it plays a pivotal role in determining treatment success. Finally, we compare the ECT methodology to conventional treatments to highlight the potential for improvement and to facilitate popularization of the technique in the area of head and neck cancers where it is not widespread yet while it is not the case with other cancer types.
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Affiliation(s)
- Arnoldas Morozas
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
| | | | - Julita Kulbacka
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
- Department of Molecular and Cellular Biology, Wroclaw Medical University, Wroclaw, Poland
| | - Justinas Ivaška
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tatjana Ivaškienė
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
| | - Vitalij Novickij
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
- Faculty of Electronics, Vilnius Gediminas Technical University, Vilnius, Lithuania
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2
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Rembiałkowska N, Novickij V, Radzevičiūtė-Valčiukė E, Mickevičiūtė E, Gajewska-Naryniecka A, Kulbacka J. Susceptibility of various human cancer cell lines to nanosecond and microsecond range electrochemotherapy: Feasibility of multi-drug cocktails. Int J Pharm 2023; 646:123485. [PMID: 37802257 DOI: 10.1016/j.ijpharm.2023.123485] [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: 06/28/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
Electrochemotherapy (ECT) involves combining anticancer drugs with electroporation, which is induced by pulsed electric fields (PEFs), while the effects vary in effectiveness based on the specific parameters of the electrical pulses and susceptibility of the cells to a specific drug. In this work, we utilized conventional microsecond electroporation protocols (0.8 - 1.5 kV/cm × 100 μs × 8, 1 Hz) and the new modality of nanosecond pulses (4 and 8 kV/cm × 500 ns × 100, 1 kHz and 1 MHz), which are compressed into a high frequency burst. Sensitive and resistant lung, breast and ovarian human cancer cell lines were used in the study. In order to overcome drug-resistance, we have investigated the feasibility to use anticancer drug cocktails i.e., bleomycin and cisplatin combinations with metformin, vinorelbine and Dp44mT. The different susceptibility of various human cancer cells lines to electric pulses was determined, the efficacy of ECT was characterized and the type of cell death depending on the combinations of drugs was investigated. The results indicate that synergistic effects of PEFs with drug cocktails may be used to overcome drug-resistance in cancer, while the application of nsPEF provides more flexibility in parametric protocols and modulation of cancer cell death.
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Affiliation(s)
- Nina Rembiałkowska
- Department of Molecular and Cellular Biology, Medical University, Borowska 211 A, 50-556, Wroclaw, Poland.
| | - Vitalij Novickij
- Faculty of Electronics, Vilnius Gediminas Technical University, 10105 Vilnius, Lithuania; State Research Institute Centre for Innovative Medicine, Department of Immunology, 08406 Vilnius, Lithuania.
| | - Eivina Radzevičiūtė-Valčiukė
- Faculty of Electronics, Vilnius Gediminas Technical University, 10105 Vilnius, Lithuania; State Research Institute Centre for Innovative Medicine, Department of Immunology, 08406 Vilnius, Lithuania.
| | - Eglė Mickevičiūtė
- State Research Institute Centre for Innovative Medicine, Department of Immunology, 08406 Vilnius, Lithuania.
| | | | - Julita Kulbacka
- Department of Molecular and Cellular Biology, Medical University, Borowska 211 A, 50-556, Wroclaw, Poland; State Research Institute Centre for Innovative Medicine, Department of Immunology, 08406 Vilnius, Lithuania.
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Campana LG, Daud A, Lancellotti F, Arroyo JP, Davalos RV, Di Prata C, Gehl J. Pulsed Electric Fields in Oncology: A Snapshot of Current Clinical Practices and Research Directions from the 4th World Congress of Electroporation. Cancers (Basel) 2023; 15:3340. [PMID: 37444450 PMCID: PMC10340685 DOI: 10.3390/cancers15133340] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The 4th World Congress of Electroporation (Copenhagen, 9-13 October 2022) provided a unique opportunity to convene leading experts in pulsed electric fields (PEF). PEF-based therapies harness electric fields to produce therapeutically useful effects on cancers and represent a valuable option for a variety of patients. As such, irreversible electroporation (IRE), gene electrotransfer (GET), electrochemotherapy (ECT), calcium electroporation (Ca-EP), and tumour-treating fields (TTF) are on the rise. Still, their full therapeutic potential remains underappreciated, and the field faces fragmentation, as shown by parallel maturation and differences in the stages of development and regulatory approval worldwide. This narrative review provides a glimpse of PEF-based techniques, including key mechanisms, clinical indications, and advances in therapy; finally, it offers insights into current research directions. By highlighting a common ground, the authors aim to break silos, strengthen cross-functional collaboration, and pave the way to novel possibilities for intervention. Intriguingly, beyond their peculiar mechanism of action, PEF-based therapies share technical interconnections and multifaceted biological effects (e.g., vascular, immunological) worth exploiting in combinatorial strategies.
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Affiliation(s)
- Luca G. Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Oxford Rd., Manchester M13 9WL, UK;
| | - Adil Daud
- Department of Medicine, University of California, 550 16 Street, San Francisco, CA 94158, USA;
| | - Francesco Lancellotti
- Department of Surgery, Manchester University NHS Foundation Trust, Oxford Rd., Manchester M13 9WL, UK;
| | - Julio P. Arroyo
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA; (J.P.A.); (R.V.D.)
| | - Rafael V. Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA; (J.P.A.); (R.V.D.)
- Institute for Critical Technology and Applied Sciences, Virginia Tech, Blacksburg, VA 24061, USA
| | - Claudia Di Prata
- Department of Surgery, San Martino Hospital, 32100 Belluno, Italy;
| | - Julie Gehl
- 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, 1165 Copenhagen, Denmark
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4
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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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Campana LG, Gehl J. Cutaneous metastases from breast cancer: Considerations for implementing rigorous evaluation of local therapies. J Surg Oncol 2022; 126:1145-1147. [DOI: 10.1002/jso.27057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Luca G. Campana
- Department of Surgery Manchester University NHS Foundation Trust Manchester UK
- Chief of the International Network for Sharing Practices of Electro‐Chemo‐Therapy (InspECT) Manchester UK
| | - Julie Gehl
- Department of Clinical Oncology and Palliative Care, Center for Experimental Drug and Gene Electrotransfer (C*EDGE) Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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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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7
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Tellado M, Mir LM, Maglietti F. Veterinary Guidelines for Electrochemotherapy of Superficial Tumors. Front Vet Sci 2022; 9:868989. [PMID: 35968026 PMCID: PMC9363792 DOI: 10.3389/fvets.2022.868989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Electrochemotherapy (ECT) consists in the application of electric pulses to increase chemotherapeutic drug intake (bleomycin, cisplatin, or calcium) into the tumor cells. It has become a very valuable treatment option in veterinary oncology. It is an effective and safe treatment modality, which is not only beneficial as a palliative treatment, but also for a curative approach. Performing the treatment adequately will ensure the best results possible, in the minimum number of sessions, and reduce complications. Usually, only one session is enough to achieve excellent results, but the treatment can be repeated. Several sessions can be necessary in the case of incompletely treated or very extended lesions, as well as in the occurrence of new lesions. ECT is effective for superficial or oral tumors of any histology that are accessible to the electrodes. Intravenous bleomycin is the preferred drug and route of administration, leaving other ways of administration and drugs for selected cases. The guidelines presented here are destined to veterinarians who want to develop their understanding of the basis of ECT and wish to perform it adequately and effectively. In this paper, we also discuss common problems and how to solve them, and we include practical tips to improve the treatment results based on common questions and mistakes of beginner users.
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Affiliation(s)
| | - Lluis M. Mir
- Université Paris-Saclay, CNRS, Gustave Roussy, Metabolic and Systemic Aspects of Oncogenesis (METSY), Île-de-France, France
| | - Felipe Maglietti
- Instituto Universitario del Hospital Italiano-CONICET, Buenos Aires, Argentina
- *Correspondence: Felipe Maglietti
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Claussen CS, Moir G, Bechara FG, Orlando A, Matteucci P, Mowatt D, Clover AJP, Mascherini M, Gehl J, Muir T, Sersa G, Groselj A, Odili J, Giorgione R, Campana LG, Bertino G, Curatolo P, Banerjee S, Kis E, Quaglino P, Pritchard-Jones R, De Terlizzi F, Grischke EM, Kunte C. Prospektive Kohortenstudie von InspECT zur Sicherheit und Wirksamkeit der Elektrochemotherapie bei Hauttumoren und Metastasen in Abhängigkeit von Ulzeration. J Dtsch Dermatol Ges 2022; 20:470-482. [PMID: 35446500 DOI: 10.1111/ddg.14699_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022]
Abstract
HINTERGRUND Elektrochemotherapie (ECT) ist eine wirksame lokale Behandlung von Hauttumoren. Ziel dieser Studie war es, die Wirksamkeit der ECT bei ulzerierten gegenüber nichtulzerierten Tumoren zu vergleichen und den Effekt auf tumorassoziierte Symptome zu untersuchen. METHODIK 20 Krebszentren des International Network for Sharing Practices on Electrochemotherapy (InspECT) sammelten prospektiv Daten. Die ECT wurde nach dem ESOPE-Protokoll durchgeführt. Das Therapieansprechen wurde anhand der Entwicklung der Läsionsgröße bewertet. Zusätzlich wurden Schmerzen, Symptome, Leistungsstatus (ECOG-Index) und Gesundheitszustand (EQ-5D-Fragebogen) untersucht. ERGEBNISSE 716 Patienten mit ulzerierten (n = 302) und nichtulzerierten (n = 414) Hauttumoren und Metastasen wurden eingeschlossen (Mindest-Nachsorge 45 Tage). Nicht-ulzerierte Läsionen sprachen besser auf die ECT an als ulzerierte Läsionen (vollständiges Ansprechen: 65 % gegenüber 51 %, p = 0,0061). Nur 38 % (115/302) der Patienten mit ulzerierten Läsionen vor der ECT wiesen bei der letzten Nachuntersuchung ulzerierte Läsionen auf. Patienten mit ulzerierten Läsionen berichteten über stärkere Schmerzen und schwerere Symptome im Vergleich zu Patienten mit nichtulzerierten Läsionen, die sich nach der ECT signifikant und kontinuierlich besserten. Bei Patienten mit nichtulzerierten Läsionen hingegen nahmen die Schmerzen während der Behandlung vorübergehend zu. Es wurden keine schwerwiegenden Nebenwirkungen beobachtet. SCHLUSSFOLGERUNGEN Die ECT ist eine sichere und wirksame lokale Behandlung von Hauttumoren. Während die ECT die Symptome insbesondere bei Patienten mit ulzerierten Läsionen verbessert, sollte auf Basis der Daten die Implementation eines perioperativen Schmerzmanagements besonders bei nichtulzerierten Läsionen während der ECT erwogen werden.
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Affiliation(s)
- Carla Sophie Claussen
- Department of Dermatosurgery and Dermatology, Artemed Clinic of Munich, Munich, Germany
| | - Graeme Moir
- The Royal London Hospital & QMUL, Bart's Health NHS Trust, Department of Cutaneous Medicine & Surgery, London, United Kingdom
| | - Falk G Bechara
- Department of Dermatologic Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Antonio Orlando
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Paolo Matteucci
- Department of Plastic surgery, Castle Hill Hospital, Cottingham, United Kingdom
| | - David Mowatt
- Plastic Surgery Department, The Christie Hospital NHS Foundation trust, Manchester, United Kingdom
| | - Anthony James P Clover
- Department of Plastic Surgery, Cork University Hospital, Cork, Ireland.,Cancer Research@UCC, Western Gateway Building, University College Cork, Cork, Ireland
| | - Matteo Mascherini
- Clinica Chirurgica 1 - Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), 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
| | - Tobian Muir
- Plastic Surgery Department, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Joy Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Luca Giovanni Campana
- Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.,Department of Surgery, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Pietro Curatolo
- Department of Dermatology and Plastic Surgery, Dermatologic Clinic, University of Roma "La Sapienza", Roma, Italy
| | - Shramana Banerjee
- Division of Surgery and interventional Science, University College London, London, United Kingdom
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | | | - Eva-Maria Grischke
- Department of Gynecology, University Hospital of Tübingen, Tübingen, Germany
| | - Christian Kunte
- Department of Dermatosurgery and Dermatology, Artemed Clinic of Munich, Munich, Germany.,Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
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Claussen CS, Moir G, Bechara FG, Orlando A, Matteucci P, Mowatt D, Clover AJP, Mascherini M, Gehl J, Muir T, Sersa G, Groselj A, Odili J, Giorgione R, Campana LG, Bertino G, Curatolo P, Banerjee S, Kis E, Quaglino P, Pritchard-Jones R, De Terlizzi F, Grischke EM, Kunte C. Prospective cohort study by InspECT on safety and efficacy of electrochemotherapy for cutaneous tumors and metastases depending on ulceration. J Dtsch Dermatol Ges 2022; 20:470-481. [PMID: 35384261 DOI: 10.1111/ddg.14699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electrochemotherapy (ECT) is an effective local treatment for cutaneous tumors. The aim of this study was to compare the effectiveness of ECT in ulcerated vs. non-ulcerated tumors and investigate the effect on tumor-associated symptoms. METHODS Twenty cancer centers in the International Network for Sharing Practices on Electrochemotherapy (InspECT) prospectively collected data. ECT was performed following ESOPE protocol. Response was evaluated by lesion size development. Pain, symptoms, performance status (ECOG-Index) and health status (EQ-5D questionnaire) were evaluated. RESULTS 716 patients with ulcerated (n = 302) and non-ulcerated (n = 414) cutaneous tumors and metastases were included (minimum follow-up of 45 days). Non-ulcerated lesions responded to ECT better than ulcerated lesions (complete response 65 % vs. 51 %, p = 0.0061). Only 38 % (115/302) with ulcerated lesions before ECT presented with ulcerated lesions at final follow-up. Patients with ulcerated lesions reported higher pain and more severe symptoms compared to non-ulcerated lesions, which significantly and continuously improved following ECT. In non-ulcerated lesions however, pain spiked during the treatment. No serious adverse events were reported. CONCLUSIONS ECT is a safe and effective local treatment for cutaneous tumors. While ECT improves symptoms especially in patients with ulcerated lesions, data suggest the implementation of a perioperative pain management in non-ulcerated lesions during ECT.
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Affiliation(s)
- Carla Sophie Claussen
- Department of Dermatosurgery and Dermatology, Artemed Clinic of Munich, Munich, Germany
| | - Graeme Moir
- The Royal London Hospital & QMUL, Barts Health NHS Trust, Department of Cutaneous Medicine & Surgery, London, United Kingdom
| | - Falk G Bechara
- Department of Dermatologic Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Antonio Orlando
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Paolo Matteucci
- Department of Plastic surgery, Castle Hill Hospital, Cottingham, United Kingdom
| | - David Mowatt
- Plastic Surgery Department, The Christie Hospital NHS Foundation trust, Manchester, United Kingdom
| | - Anthony James P Clover
- Department of Plastic Surgery, Cork University Hospital, Cork, Ireland.,Cancer Research@UCC, Western Gateway Building, University College Cork, Cork, Ireland
| | - Matteo Mascherini
- Clinica Chirurgica 1 - Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), 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
| | - Tobian Muir
- Plastic Surgery Department, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Joy Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Luca Giovanni Campana
- Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.,Department of Surgery, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Pietro Curatolo
- Department of Dermatology and Plastic Surgery, Dermatologic Clinic, University of Roma "La Sapienza", Roma, Italy
| | - Shramana Banerjee
- Division of Surgery and interventional Science, University College London, London, United Kingdom
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | | | - Eva-Maria Grischke
- Department of Gynecology, University Hospital of Tübingen, Tübingen, Germany
| | - Christian Kunte
- Department of Dermatosurgery and Dermatology, Artemed Clinic of Munich, Munich, Germany.,Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
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Fusco R, Di Bernardo E, D'Alessio V, Salati S, Cadossi M. Reduction of muscle contraction and pain in electroporation-based treatments: An overview. World J Clin Oncol 2021; 12:367-381. [PMID: 34131568 PMCID: PMC8173331 DOI: 10.5306/wjco.v12.i5.367] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/17/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the first studies of electrochemotherapy (ECT), small cutaneous metastases were treated and only mild or moderate pain was observed; therefore, pain was not considered a significant issue. As the procedure began to be applied to larger cutaneous metastases, pain was reported more frequently. For that reason, reduction of both muscle contractions and pain have been investigated over the years.
AIM To present an overview of different protocols described in literature that aim to reduce muscle contractions and pain caused by the electroporation (EP) effect in both ECT and irreversible EP treatments.
METHODS Thirty-three studies published between January 1999 and November 2020 were included. Different protocol designs and electrode geometries that reduce patient pain and the number of muscle contractions and their intensity were analysed.
RESULTS The analysis showed that both high frequency and bipolar/biphasic pulses can be used to reduce pain and muscle contractions in patients who undergo EP treatments. Moreover, adequate electrode design can decrease EP-related morbidity. Particularly, needle length, diameter and configuration of the distance between the needles can be optimised so that the muscle volume crossed by the current is reduced as much as possible. Bipolar/biphasic pulses with an inadequate pulse length seem to have a less evident effect on the membrane permeability compared with the standard pulse protocol. For that reason, the number of pulses and the voltage amplitude, as well as the pulse duration and frequency, must be chosen so that the dose of delivered energy guarantees EP efficacy.
CONCLUSION Pain reduction in EP-based treatments can be achieved by appropriately defining the protocol parameters and electrode design. Most results can be achieved with high frequency and/or bipolar/biphasic pulses. However, the efficacy of these alternative protocols remains a crucial point to be assessed further.
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Affiliation(s)
- Roberta Fusco
- Department of Medical Oncology, IGEA SpA, Carpi 41012, Modena, Italy
| | - Elio Di Bernardo
- Department of Medical Oncology, IGEA SpA, Carpi 41012, Modena, Italy
| | - Valeria D'Alessio
- Department of Medical Oncology, IGEA SpA, Carpi 41012, Modena, Italy
| | - Simona Salati
- Department of Medical Oncology, IGEA SpA, Carpi 41012, Modena, Italy
| | - Matteo Cadossi
- Department of Medical Oncology, IGEA SpA, Carpi 41012, Modena, Italy
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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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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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Biological factors of the tumour response to electrochemotherapy: Review of the evidence and a research roadmap. Eur J Surg Oncol 2021; 47:1836-1846. [PMID: 33726951 DOI: 10.1016/j.ejso.2021.03.229] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 12/18/2022] Open
Abstract
The beneficial effects of electrochemotherapy (ECT) for superficial tumours and, more recently, deep-seated malignancies in terms of local control and quality of life are widely accepted. However, the variability in responses across histotypes needs to be explored. Currently, patient selection for ECT is based on clinical factors (tumour size, histotype, and exposure to previous oncological treatments), whereas there are no biomarkers to predict the response to treatment. In this field, two major areas of investigation can be identified, i.e., tumour cell characteristics and the tumour microenvironment (vasculature, extracellular matrix, and immune infiltrate). For each of these areas, we describe the current knowledge and discuss how to foster further investigation. This review aims to provide a summary of the currently used guiding clinical factors and delineates a research roadmap for future studies to identify putative biomarkers of response to ECT. These biomarkers may allow researchers to improve ECT practice by customising treatment parameters, manipulating the tumour and its microenvironment, and exploring novel therapeutic combinations.
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Bazzolo B, Sieni E, Zamuner A, Roso M, Russo T, Gloria A, Dettin M, Conconi MT. Breast Cancer Cell Cultures on Electrospun Poly(ε-Caprolactone) as a Potential Tool for Preclinical Studies on Anticancer Treatments. Bioengineering (Basel) 2020; 8:bioengineering8010001. [PMID: 33375053 PMCID: PMC7822015 DOI: 10.3390/bioengineering8010001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/09/2020] [Accepted: 12/19/2020] [Indexed: 12/14/2022] Open
Abstract
During anticancer drug development, most compounds selected by in vitro screening are ineffective in in vivo studies and clinical trials due to the unreliability of two-dimensional (2D) in vitro cultures that are unable to mimic the cancer microenvironment. Herein, HCC1954 cell cultures on electrospun polycaprolactone (PCL) were characterized by morphological analysis, cell viability assays, histochemical staining, immunofluorescence, and RT-PCR. Our data showed that electrospun PCL allows the in vitro formation of cultures characterized by mucopolysaccharide production and increased cancer stem cell population. Moreover, PCL-based cultures were less sensitive to doxorubicin and electroporation/bleomycin than those grown on polystyrene plates. Collectively, our data indicate that PCL-based cultures may be promising tools for preclinical studies.
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Affiliation(s)
- Bianca Bazzolo
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padova, Italy; (B.B.); (M.T.C.)
| | - Elisabetta Sieni
- Department of Theoretical and Applied Sciences, University of Insubria, via Dunant, 3, 21100 Varese, Italy
- Correspondence:
| | - Annj Zamuner
- Department of Industrial Engineering, University of Padova, via Marzolo, 9, 35131 Padova, Italy; (A.Z.); (M.R.); (M.D.)
| | - Martina Roso
- Department of Industrial Engineering, University of Padova, via Marzolo, 9, 35131 Padova, Italy; (A.Z.); (M.R.); (M.D.)
| | - Teresa Russo
- Institute of Polymers, Composites and Biomaterials, National Research Council of Italy, V.le J.F. Kennedy 54-Mostra d’Oltremare Pad. 20, 80125 Naples, Italy; (T.R.); (A.G.)
| | - Antonio Gloria
- Institute of Polymers, Composites and Biomaterials, National Research Council of Italy, V.le J.F. Kennedy 54-Mostra d’Oltremare Pad. 20, 80125 Naples, Italy; (T.R.); (A.G.)
| | - Monica Dettin
- Department of Industrial Engineering, University of Padova, via Marzolo, 9, 35131 Padova, Italy; (A.Z.); (M.R.); (M.D.)
| | - Maria Teresa Conconi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padova, Italy; (B.B.); (M.T.C.)
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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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Nemec A, Milevoj N, Lampreht Tratar U, Serša G, Čemažar M, Tozon N. Electroporation-Based Treatments in Small Animal Veterinary Oral and Maxillofacial Oncology. Front Vet Sci 2020; 7:575911. [PMID: 33134356 PMCID: PMC7550461 DOI: 10.3389/fvets.2020.575911] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022] Open
Abstract
Electroporation is a method of inducing an increase in permeability of the cell membrane through the application of an electric field and can be used as a delivery method for introducing molecules of interest (e.g., chemotherapeutics or plasmid DNA) into cells. Electroporation-based treatments (i.e., electrochemotherapy, gene electrotransfer, and their combinations) have been shown to be safe and effective in veterinary oncology, but they are currently mostly recommended for the treatment of those solid tumors for which clients have declined surgery and/or radiotherapy. Published data show that electroporation-based treatments are also safe, simple, fast and cost-effective treatment alternatives for selected oral and maxillofacial tumors, especially small squamous cell carcinoma and malignant melanoma tumors not involving the bone in dogs. In these patients, a good local response to treatment is expected to result in increased survival time with good quality of life. Despite emerging evidence of the clinical efficacy of electroporation-based treatments for oral and maxillofacial tumors, further investigation is needed to optimize treatment protocols, improve clinical data reporting and better understand the mechanisms of patients' response to the treatment.
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Affiliation(s)
- Ana Nemec
- Small Animal Clinic, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Milevoj
- Small Animal Clinic, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Gregor Serša
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Maja Čemažar
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Nataša Tozon
- Small Animal Clinic, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
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Electrochemotherapy in the treatment of cutaneous malignancy: Outcomes and subgroup analysis from the cumulative results from the pan-European International Network for Sharing Practice in Electrochemotherapy database for 2482 lesions in 987 patients (2008-2019). Eur J Cancer 2020; 138:30-40. [PMID: 32836172 DOI: 10.1016/j.ejca.2020.06.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/01/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Electrochemotherapy (ECT) is a treatment for both primary and secondary cutaneous tumours. The international Network for sharing practices on ECT group investigates treatment outcomes after ECT using a common database with defined parameters. METHODS Twenty-eight centres across Europe prospectively uploaded data over an 11-year period. Response rates were investigated in relation to primary diagnosis, tumour size, choice of electrode type, route of bleomycin administration, electrical parameters recorded and previous irradiation in the treated field. RESULTS Nine hundred eighty-seven patients, with 2482 tumour lesions were included in analysis. The overall response (OR) rate was 85% (complete response [CR]: 70%, partial response rate: 15%, stable disease: 11%, and progressive disease: 2%). For different histologies, OR and CR rates for metastases of malignant melanoma were 82% and 64%, basal cell carcinoma were 96% and 85%, breast cancer metastases were 77% and 62%, squamous cell carcinoma were 80% and 63% as well as Kaposi's sarcoma were 98% and 91%, respectively. Variance was demonstrated across histotypes (p < 0.0001) and in accordance with size of lesion treated (dichotomised at diameter of 3 cm (p < 0.0001). Hexagonal electrodes were generally used for larger tumours, but for tumours up to 3 cm, linear array electrodes provided better tumour control than hexagonal electrodes (80%:74%, p < 0.003). For tumours more than 2 cm, intravenous administration was superior to intratumoural (IT) administration (p < 0.05). Current recorded varied across tumour histologies and size but did not influence response rate. In previously irradiated areas, responses were selectively lower for IT administration. CONCLUSIONS These cumulative data endorse efficiency of ECT across a broad range of histotypes. Analysis of 2482 lesions details subgroup analysis on treatment response informing future treatment choices.
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Doxorubicin Assisted by Microsecond Electroporation Promotes Irreparable Morphological Alternations in Sensitive and Resistant Human Breast Adenocarcinoma Cells. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10082765] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Electroporation increases the transmembrane transport of molecules. The combination of electric pulses with cytostatic compounds is beneficial for cancer treatment. Doxorubicin (DOX) is a commonly used chemotherapeutic anticancer drug. Its fluorescence properties enable the investigation of drug distribution and metabolism. In this study, doxorubicin was enhanced by electroporation to eliminate cancer cells more effectively. The influence of electroporation on the drug uptake was evaluated in two cell lines: MCF-7/WT and MCF-7/DOX. The intracellular localization of doxorubicin and its impact on the intracellular structure organization were examined under a confocal microscope. Cellular effects were examined with the 3(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test that estimates the rate of metabolism in viable cells. The ultrastructure (TEM) of tumor cells subjected to the electric field was analyzed. An enhanced doxorubicin efficacy was observed in MCF-7/DOX cells after combination with electroporation. The response of the resistant cell line was revealed to be more sensitive to electric pulses. Electroporation-based methods may be attractive for cancer treatment in human breast adenocarcinoma, especially with acquired resistance. Electroporation enables a reduction of the effective dose of the drugs and the exposure time in this type of cancer, diminishing side effects of the systemic therapy.
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Ágoston D, Baltás E, Ócsai H, Rátkai S, Lázár PG, Korom I, Varga E, Németh IB, Dósa-Rácz Viharosné É, Gehl J, Oláh J, Kemény L, Kis EG. Evaluation of Calcium Electroporation for the Treatment of Cutaneous Metastases: A Double Blinded Randomised Controlled Phase II Trial. Cancers (Basel) 2020; 12:E179. [PMID: 31936897 PMCID: PMC7017133 DOI: 10.3390/cancers12010179] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
Calcium electroporation (Ca-EP) is a new anticancer treatment providing similar features to electrochemotherapy (ECT). The aim of our study is to compare the efficacy of Ca-EP with bleomycin-based ECT. This double-blinded randomized controlled phase II study was conducted at the Medical University of Szeged, Hungary. During this once only treatment up to ten measurable cutaneous metastases per patient were separately block randomized for intratumoral delivery of either calcium or bleomycin, which was followed by reversible electroporation. Tumour response was evaluated clinically and histologically six months after treatment. (ClinicalTrials.gov: NCT03628417, closed). Seven patients with 44 metastases (34 from malignant melanoma, 10 from breast cancer) were included in the study. Eleven metastases were taken for biopsies, and 33 metastases were randomised and treated once. The objective response rates were 33% (6/18) for Ca-EP and 53% (8/15) for bleomycin-based ECT, with 22% (4/18) and 40% (6/15) complete response rates, respectively. The CR was confirmed histologically in both arms. Serious adverse events were not registered. Ulceration and hyperpigmentation, both CTCA criteria grade I side effects, were observed more frequently after bleomycin-based ECT than for Ca-EP. Ca-EP was non-inferior to ECT, therefore, it should be considered as a feasible, effective and safe treatment option.
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Affiliation(s)
- Dóra Ágoston
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary; (D.Á.); (E.B.); (H.Ó.); (S.R.); (I.K.); (E.V.); (I.B.N.); (É.D.-R.V.); (L.K.)
| | - Eszter Baltás
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary; (D.Á.); (E.B.); (H.Ó.); (S.R.); (I.K.); (E.V.); (I.B.N.); (É.D.-R.V.); (L.K.)
| | - Henriette Ócsai
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary; (D.Á.); (E.B.); (H.Ó.); (S.R.); (I.K.); (E.V.); (I.B.N.); (É.D.-R.V.); (L.K.)
| | - Sándor Rátkai
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary; (D.Á.); (E.B.); (H.Ó.); (S.R.); (I.K.); (E.V.); (I.B.N.); (É.D.-R.V.); (L.K.)
| | - Péter Gy Lázár
- Department of Oral and Maxillofacial Surgery, University of Szeged, 6720 Szeged, Hungary;
| | - Irma Korom
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary; (D.Á.); (E.B.); (H.Ó.); (S.R.); (I.K.); (E.V.); (I.B.N.); (É.D.-R.V.); (L.K.)
| | - Erika Varga
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary; (D.Á.); (E.B.); (H.Ó.); (S.R.); (I.K.); (E.V.); (I.B.N.); (É.D.-R.V.); (L.K.)
| | - István Balázs Németh
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary; (D.Á.); (E.B.); (H.Ó.); (S.R.); (I.K.); (E.V.); (I.B.N.); (É.D.-R.V.); (L.K.)
| | - Éva Dósa-Rácz Viharosné
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary; (D.Á.); (E.B.); (H.Ó.); (S.R.); (I.K.); (E.V.); (I.B.N.); (É.D.-R.V.); (L.K.)
| | - 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
| | - Judit Oláh
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary;
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary; (D.Á.); (E.B.); (H.Ó.); (S.R.); (I.K.); (E.V.); (I.B.N.); (É.D.-R.V.); (L.K.)
| | - Erika Gabriella Kis
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary; (D.Á.); (E.B.); (H.Ó.); (S.R.); (I.K.); (E.V.); (I.B.N.); (É.D.-R.V.); (L.K.)
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Electrochemotherapy for the palliative management of cutaneous metastases: A systematic review and meta-analysis. Eur J Surg Oncol 2019; 45:2257-2267. [DOI: 10.1016/j.ejso.2019.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022] Open
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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, Mocellin S, Snoj M, Sersa G. A Dedicated Checklist to Improve the Quality of Reporting in Electrochemotherapy and Enable Comparisons with Other Skin-directed Therapies. Clin Oncol (R Coll Radiol) 2019; 32:e127-e128. [PMID: 31699489 DOI: 10.1016/j.clon.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- L G Campana
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy.
| | - S Mocellin
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy; Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - M Snoj
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - G Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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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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Campana LG, Bullo M, Di Barba P, Dughiero F, Forzan M, Mognaschi ME, Sgarbossa P, Tosi AL, Bernardis A, Sieni E. Effect of Tissue Inhomogeneity in Soft Tissue Sarcomas: From Real Cases to Numerical and Experimental Models. Technol Cancer Res Treat 2018; 17:1533033818789693. [PMID: 30045667 PMCID: PMC6071161 DOI: 10.1177/1533033818789693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Electrochemotherapy is an established treatment option for patients with superficially
metastatic tumors, mainly malignant melanoma and breast cancer. Based on preliminary
experiences, electrochemotherapy has the potential to be translated in the treatment of
larger and deeper neoplasms, such as soft tissue sarcomas. However, soft tissue sarcomas
are characterized by tissue inhomogeneity and, consequently, by variable electrical
characteristic of tumor tissue. The inhomogeneity in conductivity represents the cause of
local variations in the electric field intensity. Crucially, this fact may hamper the
achievement of the electroporation threshold during the electrochemotherapy procedure. In
order to evaluate the effect of tissue inhomogeneity on the electric field distribution,
we first performed ex vivo analysis of some clinical cases to quantify
the inhomogeneity area. Subsequently, we performed some simulations where the electric
field intensity was evaluated by means of finite element analysis. The results of the
simulation models are finally compared to an experimental model based on potato and tissue
mimic materials. Tissue mimic materials are materials where the conductivity can be
suitably designed. The coupling of computation and experimental results could be helpful
to show the effect of the inhomogeneity in terms of variation in electric field
distribution and characteristics.
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Affiliation(s)
- Luca Giovanni Campana
- 1 Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.,2 Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Marco Bullo
- 3 Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Paolo Di Barba
- 4 Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Fabrizio Dughiero
- 3 Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Michele Forzan
- 3 Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Maria Evelina Mognaschi
- 4 Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Paolo Sgarbossa
- 3 Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Anna Lisa Tosi
- 5 Melanoma and Sarcoma Pathology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Alessia Bernardis
- 3 Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Elisabetta Sieni
- 3 Department of Industrial Engineering, University of Padova, Padova, Italy
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Ongaro A, Campana LG, De Mattei M, Di Barba P, Dughiero F, Forzan M, Mognaschi ME, Pellati A, Rossi CR, Bernardello C, Sieni E. Effect of Electrode Distance in Grid Electrode: Numerical Models and In Vitro Tests. Technol Cancer Res Treat 2018; 17:1533033818764498. [PMID: 29558871 PMCID: PMC5863864 DOI: 10.1177/1533033818764498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Electrochemotherapy is an emerging local treatment for the management of superficial tumors and, among these, also chest wall recurrences from breast cancer. Generally, the treatment of this peculiar type of tumor requires the coverage of large skin areas. In these cases, electrochemotherapy treatment by means of standard small size needle electrodes (an array of 0.73 cm spaced needles, which covers an area of 1.5 cm2) is time-consuming and can allow an inhomogeneous coverage of the target area. We have previously designed grid devices suitable for treating an area ranging from 12 to 200 cm2. In this study, we propose different approaches to study advantages and drawbacks of a grid device with needles positioned 2 cm apart. The described approach includes a numerical evaluation to estimate electric field intensity, followed by an experimental quantification of electroporation on a cell culture. The electric field generated in a conductive medium has been studied by means of 3-dimensional numerical models with varying needle pair distance from 1 to 2 cm. In particular, the electric field evaluation shows that the electric field intensity with varying needle distance is comparable in the area in the middle of the 2 electrodes. Differently, near needles, the electric field intensity increases with the increasing electrode distance and supply voltage. The computational results have been correlated with experimental ones obtained in vitro on cell culture. In particular, electroporation effect has been assessed on human breast cancer cell line MCF7, cultured in monolayer. The use of 2-cm distant needles, supplied by 2000 V, produced an electroporation effect in the whole area comprised between the electrodes. Areas of cell culture where reversible and irreversible electroporation occurred were identified under microscope by using fluorescent dyes. The coupling of computation and experimental results could be helpful to evaluate the effect of the needle distance on the electric field intensity in cell cultures in terms of reversible or irreversible electroporation.
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Affiliation(s)
- Alessia Ongaro
- 1 Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Luca Giovanni Campana
- 2 Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.,3 Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Monica De Mattei
- 1 Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Paolo Di Barba
- 4 Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Fabrizio Dughiero
- 5 Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Michele Forzan
- 5 Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Maria Evelina Mognaschi
- 4 Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Agnese Pellati
- 1 Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Carlo Riccardo Rossi
- 2 Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.,3 Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Clara Bernardello
- 5 Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Elisabetta Sieni
- 5 Department of Industrial Engineering, University of Padova, Padova, Italy
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Campana LG, Edhemovic I, Soden D, Perrone AM, Scarpa M, Campanacci L, Cemazar M, Valpione S, Miklavčič D, Mocellin S, Sieni E, Sersa G. Electrochemotherapy - Emerging applications technical advances, new indications, combined approaches, and multi-institutional collaboration. Eur J Surg Oncol 2018; 45:92-102. [PMID: 30528893 DOI: 10.1016/j.ejso.2018.11.023] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/30/2018] [Indexed: 12/18/2022] Open
Abstract
The treatment of tumors with electrochemotherapy (ECT) has surged over the past decade. Thanks to the transient cell membrane permeabilization induced by the short electric pulses used by ECT, cancer cells are exposed to otherwise poorly permeant chemotherapy agents, with consequent increased cytotoxicity. The codification of the procedure in 2006 led to a broad diffusion of the procedure, mainly in Europe, and since then, the progressive clinical experience, together with the emerging technologies, have extended the range of its application. Herein, we review the key advances in the ECT field since the European Standard Operating Procedures on ECT (ESOPE) 2006 guidelines and discuss the emerging clinical data on the new ECT indications. First, technical developments have improved ECT equipment, with custom electrode probes and dedicated tools supporting individual treatment planning in anatomically challenging tumors. Second, the feasibility and short-term efficacy of ECT has been established in deep-seated tumors, including bone metastases, liver malignancies, and pancreatic and prostate cancers (long-needle variable electrode geometry ECT), and gastrointestinal tumors (endoscopic ECT). Moreover, pioneering studies indicate lung and brain tumors as suitable future targets. A further advance relates to new combination strategies with immunotherapy, gene electro transfer (GET), calcium EP, and radiotherapy. Finally and fourth, cross-institutional collaborative groups have been established to refine procedural guidelines, promote clinical research, and explore new indications.
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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.
| | - Ibrahim Edhemovic
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Anna M Perrone
- Oncologic Gynecology Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Scarpa
- Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Laura Campanacci
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Sara Valpione
- Christie NHS Foundation Trust, CRUK Manchester Institute, The University of Manchester, Manchester, M20 4GJ, UK
| | - Damijan Miklavčič
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Simone Mocellin
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy; Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Elisabetta Sieni
- Department of Industrial Engineering, University of Padua, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology 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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Gehl J, Sersa G, Matthiessen LW, Muir T, Soden D, Occhini A, Quaglino P, Curatolo P, Campana LG, Kunte C, Clover AJP, Bertino G, Farricha V, Odili J, Dahlstrom K, Benazzo M, Mir LM. Updated standard operating procedures for electrochemotherapy of cutaneous tumours and skin metastases. Acta Oncol 2018; 57:874-882. [PMID: 29577784 DOI: 10.1080/0284186x.2018.1454602] [Citation(s) in RCA: 209] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 03/13/2018] [Indexed: 12/21/2022]
Abstract
Electrochemotherapy is now in routine clinical use to treat cutaneous metastases of any histology, and is listed in national and international guidelines for cutaneous metastases and primary skin cancer. Electrochemotherapy is used by dermatologists, surgeons, and oncologists, and for different degrees and manifestations of metastases to skin and primary skin tumours not amenable to surgery. This treatment utilises electric pulses to permeabilize cell membranes in tumours, thus allowing a dramatic increase of the cytotoxicity of anti-cancer agents. Response rates, often after only one treatment, are very high across all tumour types. The most frequent indications are cutaneous metastases from malignant melanoma and breast cancer. In 2006, standard operating procedures (SOPs) were written for this novel technology, greatly facilitating introduction and dissemination of the therapy. Since then considerable experience has been obtained treating a wider range of tumour histologies and increasing size of tumours which was not originally thought possible. A pan-European expert panel drawn from a range of disciplines from dermatology, general surgery, head and neck surgery, plastic surgery, and oncology met to form a consensus opinion to update the SOPs based on the experience obtained. This paper contains these updated recommendations for indications for electrochemotherapy, pre-treatment information and evaluation, treatment choices, as well as follow-up.
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Affiliation(s)
- Julie Gehl
- a Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care , Zealand University Hospital , Roskilde , Denmark
- b Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
- c Department of Oncology Herlev and Gentofte Hospital , University of Copenhagen , Herlev , Denmark
| | - Gregor Sersa
- d Department of Experimental Oncology , Institute of Oncology Ljubljana , Ljubljana , Slovenia
| | | | - Tobian Muir
- e South Tees NHS Foundation Trust , James Cook University Hospital , Middlesbrough , UK
| | - Declan Soden
- f Cork Cancer Research Centre , Western Gateway Building University College Cork , Cork , Ireland
| | - Antonio Occhini
- g Department of Otolaryngology Head and Neck Surgery , University of Pavia - IRCCS Policlinico San Matteo Foundation , Pavia , Italy
| | - Pietro Quaglino
- h Department of Medical Sciences , Dermatologic Clinic, University of Turin , Turin , Italy
| | - Pietro Curatolo
- i Department of Dermatology and Plastic Surgery , La Sapienza University , Roma , Italy
| | - Luca G Campana
- j Department of Surgery Oncology and Gastroenterology (DISCOG) , University of Padova , Padova , Italy
- k Surgical Oncology Unit , Veneto Institute of Oncology IRCCS , Padova , Italy
| | - Christian Kunte
- l Department of Dermatologic Surgery and Dermatology , Artemed Fachklinik München , Munich , Germany
- m Department of Dermatology and Allergology , Ludwig-Maximillian University , Munich , Germany
| | - A James P Clover
- f Cork Cancer Research Centre , Western Gateway Building University College Cork , Cork , Ireland
- n Department of Plastic Surgery , Cork University Hospital , Cork , Ireland
| | - Giulia Bertino
- f Cork Cancer Research Centre , Western Gateway Building University College Cork , Cork , Ireland
| | - Victor Farricha
- o Melanoma and Sarcoma Unit Department of Surgery , Portuguese Institute of Oncology, Rua Professor Lima Basto, Faculty of Medicine of Lisbon , Lisbon , Portugal
| | - Joy Odili
- p Department of Plastic Surgery , St. George's University Hospitals NHS Foundation Trust , London , UK
| | - Karin Dahlstrom
- q Department of Plastic Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Marco Benazzo
- g Department of Otolaryngology Head and Neck Surgery , University of Pavia - IRCCS Policlinico San Matteo Foundation , Pavia , Italy
| | - Lluis M Mir
- r Vectorology and Anticancer Therapies , UMR 8203, CNRS, Univ. Paris-Sud, Gustave Roussy, Université Paris-Saclay , Villejuif , France
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Prasath V, Habibi M. Recent Trends in Local-Regional Recurrence Rates: Implications for Therapeutic Intervention. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0270-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Falk H, Matthiessen L, Wooler G, Gehl J. Calcium electroporation for treatment of cutaneous metastases; a randomized double-blinded phase II study, comparing the effect of calcium electroporation with electrochemotherapy. Acta Oncol 2018; 57:311-319. [PMID: 28816072 DOI: 10.1080/0284186x.2017.1355109] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Calcium electroporation is a novel anticancer treatment, which utilizes high voltage pulses to permeabilize cell membranes and expose the cell to supraphysiological doses of calcium. Preclinical studies on calcium electroporation have shown strikingly high tumor response with cell necrosis. Calcium electroporation builds on the treatment electrochemotherapy, where chemotherapeutic drugs, mostly bleomycin, are internalized by electroporation. This double-blinded randomized study compared calcium electroporation to electrochemotherapy in terms of objective response measured 6 months after treatment. METHODS Seven patients with a total of 47 cutaneous metastases from breast cancer and malignant melanoma were included in the protocol. A total of 37 metastases were randomized and evaluated for response, another 10 metastases were used for biopsy. This was a non-inferiority trial and metastases were randomized individually in each patient to either intratumoral calcium or bleomycin followed by application of electric pulses to tumor site. All metastases were treated once, and after 6-months of follow-up, the randomization code was revealed. RESULTS Objective response of calcium electroporation was 72% (13/18) with complete response in 66% (12/18). For electrochemotherapy, objective response was 84% (16/19) with complete response in 68% (13/19). There was no statistically significant difference between the two treatments (p = 0.5). After 1 year, only three out of 25 metastases had relapsed. Ulceration, itching and exudation were reported slightly more frequently in metastases treated with bleomycin, and hyperpigmentation was only seen in metastases treated with bleomycin. CONCLUSION This study shows that calcium electroporation is feasible and effective in patients with cutaneous metastases.
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Affiliation(s)
- H. Falk
- Center for Experimental Drug and Gene Electrotransfer CEDGE, Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - L.W. Matthiessen
- Center for Experimental Drug and Gene Electrotransfer CEDGE, Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - G. Wooler
- Department of Pathology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - J. Gehl
- Center for Experimental Drug and Gene Electrotransfer CEDGE, Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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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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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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Campana LG, Marconato R, Valpione S, Galuppo S, Alaibac M, Rossi CR, Mocellin S. Basal cell carcinoma: 10-year experience with electrochemotherapy. J Transl Med 2017; 15:122. [PMID: 28569161 PMCID: PMC5452531 DOI: 10.1186/s12967-017-1225-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/27/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Electrochemotherapy (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. METHODS In 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. RESULTS Disease 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). CONCLUSIONS One 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).
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Affiliation(s)
- Luca G Campana
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy. .,Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, Italy.
| | | | - Sara Valpione
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy.,Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | - Sara Galuppo
- Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mauro Alaibac
- Dermatology Unit, University of Padova, Padua, Italy
| | - Carlo R Rossi
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, Italy
| | - Simone Mocellin
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, Italy
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Falk H, Forde PF, Bay ML, Mangalanathan UM, Hojman P, Soden DM, Gehl J. Calcium electroporation induces tumor eradication, long-lasting immunity and cytokine responses in the CT26 colon cancer mouse model. Oncoimmunology 2017. [PMID: 28638724 DOI: 10.1080/2162402x.2017.1301332] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Electroporation is used in cancer treatment because of its ability to increase local cytotoxicity of e.g. bleomycin (electrochemotherapy) and calcium (calcium electroporation). Calcium electroporation is a novel anticancer treatment that selectively kills cancer cells by necrosis, a cell death pathway that stimulates the immune system due to high release of antigens and "danger signals." In this exploratory study, we aimed to investigate whether calcium electroporation could initiate an anticancer immune response similar to electrochemotherapy. To this end, we treated immunocompetent balb/c mice with CT26 colon tumors with calcium electroporation, electrochemotherapy, or ultrasound-based delivery of calcium or bleomycin. High treatment efficiency was observed with 100% complete remission in all four groups (12/12 with complete remission in each treatment group). In addition, none of the surviving mice from these groups formed new tumors when re-challenged with CT26 cancer cells 100-d post treatment, whereas mice challenged with different cancer cells (4T1 breast cancer) all developed tumors. Treatment of immunodeficient mice with calcium electroporation and electrochemotherapy showed no long-lasting tumor response. Calcium electroporation and electrochemotherapy was associated with a release of High Mobility Group Box 1 protein (HMGB1) in vitro (p = 0.029) and a significant increase of the overall systemic level of pro-inflammatory cytokines in serum from the treated mice (p < 0.003). These findings indicate that calcium electroporation as well as electrochemotherapy could have a role as immune stimulators in future treatments.
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Affiliation(s)
- Hanne Falk
- Center for Experimental Drug and Gene Electrotransfer (CEDGE), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej, Herlev, Denmark
| | - Patrick F Forde
- Cork Cancer Research Center, Western Gateway Building, University College Cork, Western road, Cork, Ireland
| | - Marie Lund Bay
- Centre of Physical Activity Research, Center of Inflammation and Metabolism, Copenhagen University Hospital, Blegdamsvej, København, Denmark
| | - Uma Maheswari Mangalanathan
- Center for Experimental Drug and Gene Electrotransfer (CEDGE), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej, Herlev, Denmark
| | - Pernille Hojman
- Centre of Physical Activity Research, Center of Inflammation and Metabolism, Copenhagen University Hospital, Blegdamsvej, København, Denmark
| | - Declan M Soden
- Cork Cancer Research Center, Western Gateway Building, University College Cork, Western road, Cork, Ireland
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (CEDGE), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej, Herlev, Denmark
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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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Tarantino L, Busto G, Nasto A, Fristachi R, Cacace L, Talamo M, Accardo C, Bortone S, Gallo P, Tarantino P, Nasto RA, Di Minno MND, Ambrosino P. Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis: A feasibility study. World J Gastroenterol 2017; 23:906-918. [PMID: 28223736 PMCID: PMC5296208 DOI: 10.3748/wjg.v23.i5.906] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/14/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4- portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feasibility, safety and efficacy of this new non thermal ablative technique in those patients.
METHODS Six patients (5 males and 1 female), aged 61-85 years (mean age, 70 years), four in Child-Pugh A and two in Child-Pugh B class, entered our study series. All patients were studied with three-phase computed tomography (CT), contrast enhanced ultrasound (CEUS) and ultrasound-guided percutaneous biopsy of the thrombus before ECT. All patients underwent ECT treatment (Cliniporator Vitae®, IGEA SpA, Carpi, Modena, Italy) of Vp3-Vp4 PVTT in a single session. At the end of the procedure a post-treatment biopsy of the thrombus was performed. Scheduled follow-up in all patients entailed: CEUS within 24 h after treatment; triphasic contrast-enhanced CT and CEUS at 3 mo after treatment and every six months thereafter.
RESULTS Post-treatment CEUS showed complete absence of enhancement of the treated thrombus in all cases. Post-treatment biopsy showed apoptosis and necrosis of tumor cells in all cases. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patients, the follow-up CT and CEUS demonstrated complete patency of the treated portal vein. Other 3 patients showed a persistent avascular non-tumoral shrinked thrombus at CEUS and CT during follow-up. No local recurrence was observed at follow-up CT and CEUS in 5/6 patients. One patient was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after ECT.
CONCLUSION In patients with cirrhosis, ECT seems effective and safe for curative treatment of Vp3-Vp4 PVTT from HCC.
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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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Campana L, Testori A, Curatolo P, Quaglino P, Mocellin S, Framarini M, Borgognoni L, Ascierto P, Mozzillo N, Guida M, Bucher S, Rotunno R, Marenco F, De Salvo G, De Paoli A, Rossi C, Bonadies A. Treatment efficacy with electrochemotherapy: A multi-institutional prospective observational study on 376 patients with superficial tumors. Eur J Surg Oncol 2016; 42:1914-1923. [DOI: 10.1016/j.ejso.2016.06.399] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 12/21/2022] Open
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Microscopic histological characteristics of soft tissue sarcomas: analysis of tissue features and electrical resistance. Med Biol Eng Comput 2016; 55:1097-1108. [DOI: 10.1007/s11517-016-1573-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 09/15/2016] [Indexed: 12/21/2022]
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Pellegrino A, Damiani GR, Mangioni C, Strippoli D, Loverro G, Cappello A, Turoli Scd D, Corso S, Tartagni M, Pezzotta MG. Outcomes of Bleomycin-based electrochemotherapy in patients with repeated loco-regional recurrences of vulvar cancer. Acta Oncol 2016; 55:619-24. [PMID: 26882959 DOI: 10.3109/0284186x.2015.1117134] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective To evaluate the safety, local tumor efficacy and relief of symptoms of electrochemotherapy (ECT) treatment in patients affected by recurrence of vulvar cancer (VC), unsuitable for standard treatments. Methods Ten patients were recruited with histological diagnosis of recurrence of VC. Intravenous bleomycin was injected, after an accurate mapping of all lesions and ECT was performed. Response to therapy was evaluated and quality of life (QoL) was evaluated via questionnaires. Results Diagnosis stage of primary tumors, according to the FIGO system, was: four patients respectively at stage IB (40%), and at stage II (40%), one patient at stage IIIA (10%), one patient with Paget cancer (10%). Mean age was 76 years (SD ± 7) at time of enrollment. Eight patients (80%) were previously submitted to surgery and/or radio-chemotherapy. Mean treatment time was 20 (range 10-20) min. After a median follow-up of 12 (3-22) months, six patients (60%) were alive. Conclusions Objective responses (ORs) with local control of the tumor were obtained in 80%. After a mean follow-up of 12 (3-22) months six patients (60%) were alive. The favorable outcome of this study, indicates that ECT is a reliable treatment option that may improve their functioning, thus enhancing the care provided in the palliative setting.
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Affiliation(s)
- Antonio Pellegrino
- Department of Obstetrics and Gynecology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Gianluca Raffaello Damiani
- Department of Obstetrics and Gynecology, Alessandro Manzoni Hospital, Lecco, Italy
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Di Lodi, Milan, Italy
- Department of dermatology, Alessandro Manzoni Hospital, Lecco, Italy
- Alessandro Manzoni Hospital, Lecco, Italy
| | - Costantino Mangioni
- Department of Obstetrics and Gynecology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Davide Strippoli
- Department of dermatology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Giuseppe Loverro
- Department of Obstetrics and Gynecology, University of Bari, Italy
| | - Antonio Cappello
- Department of Radiology, Alessandro Manzoni Hospital, Lecco, Italy
| | | | - Silvia Corso
- Department of Obstetrics and Gynecology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Massimo Tartagni
- Department of Obstetrics and Gynecology, University of Bari, Italy
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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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Campana LG, Dughiero F, Forzan M, Rossi CR, Sieni E. A prototype of a flexible grid electrode to treat widespread superficial tumors by means of Electrochemotherapy. Radiol Oncol 2016; 50:49-57. [PMID: 27069449 PMCID: PMC4825332 DOI: 10.1515/raon-2016-0013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/20/2016] [Indexed: 12/21/2022] Open
Abstract
Background In recent years, superficial chest wall recurrence from breast cancer can be effectively treated by means of electrochemotherapy, with the majority of patients achieving response to treatment. Nevertheless, tumor spread along superficial lymphatic vessels makes this peculiar type of tumor recurrence prone to involve large skin areas and difficult to treat. In these cases, electroporation with standard, small size needle electrodes can be time-consuming and produce an inhomogeneous coverage of the target area, ultimately resulting in patient under treatment. Materials and methods Authors designed and developed a prototype of a flexible grid electrode aimed at the treatment of large skin surfaces and manufactured a connection box to link the pulse applicator to a voltage pulse generator. Laboratory tests on potato tissue were performed in order to evaluate the electroporation effect, which was evaluated by observing color change of treated tissue. Results A device has been designed in order to treat chest wall recurrences from breast cancer. According to preliminary tests, the new flexible support of the electrode allows the adaptability to the surface to be treated. Moreover, the designed devices can be useful to treat a larger surface in 2–5 minutes. Conclusions Authors developed the prototype of a new pulse applicator aimed at the treatment of widespread superficial tumors. This flexible grid needle electrode was successfully tested on potato tissue and produced an electroporation effect. From a clinical point of view, the development of this device may shorten electrochemotherapy procedure thus allowing clinicians to administer electric pulses at the time of maximum tumor exposure to drugs. Moreover, since the treatment time is 2–5 min long, it could also reduce the time of anesthesia, thus improving patient recovery.
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Affiliation(s)
| | | | - Michele Forzan
- Department of Industrial Engineering, University of Padova, Italy
| | | | - Elisabetta Sieni
- Department of Industrial Engineering, University of Padova, Italy
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Gardiner RE, Jahangeer S, Forde P, Ariffin AB, Bird B, Soden D, Hinchion J. Low immunogenicity in non-small cell lung cancer; do new developments and novel treatments have a role? Cancer Metastasis Rev 2016; 34:129-44. [PMID: 25726003 DOI: 10.1007/s10555-015-9550-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Approximately 1.6 million new cases of lung cancer are diagnosed annually (Jemal et al. CA: A Cancer Journal for Clinicians, 61, 69-90, 2011) and it remains the leading cause of cancer-related mortality worldwide. Despite decades of bench and clinical research to attempt to improve outcome for locally advanced, good performance status patients, the 5-year survival remains less than 15 % (Molina et al. 2008). Immune checkpoint inhibitor (ICH) therapies have shown a significant promise in preclinical and clinical trails to date in the treatment of non-small cell lung cancer (NSCLC). The idea of combining these systemic immune therapies with local ablative techniques is one that is gaining momentum. Electrochemotherapy (ECT) is a unique atraumatic local therapy that has had very promising objective response rates and a number of advantages including but not limited to its immunostimulatory effects. ECT in combination with ICHs offers a novel approach for dealing with this difficult disease process.
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Affiliation(s)
- R E Gardiner
- Cork Cancer Research Centre, University College Cork, Cork, Ireland,
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Campana LG, Cesari M, Dughiero F, Forzan M, Rastrelli M, Rossi CR, Sieni E, Tosi AL. Electrical resistance of human soft tissue sarcomas: an ex vivo study on surgical specimens. Med Biol Eng Comput 2015; 54:773-87. [PMID: 26324245 DOI: 10.1007/s11517-015-1368-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 08/07/2015] [Indexed: 12/17/2022]
Abstract
This paper presents a study about electrical resistance, which using fixed electrode geometry could be correlated to the tissue resistivity, of different histological types of human soft tissue sarcomas measured during electroporation. The same voltage pulse sequence was applied to the tumor mass shortly after surgical resection by means of a voltage pulse generator currently used in clinical practice for electrochemotherapy that uses reversible electroporation. The voltage pulses were applied by means of a standard hexagonal electrode composed by seven, 20-mm-long equispaced needles. Irrespective of tumor size, the electrode applies electric pulses to the same volume of tissue. The resistance value was computed from the voltage and current recorded by the pulse generator, and it was correlated with the histological characteristics of the tumor tissue which was assessed by a dedicated pathologist. Some differences in resistance values, which could be correlated to a difference in tissue resistivity, were noticed according to sarcoma histotype. Lipomatous tumors (i.e., those rich in adipose tissue) displayed the highest resistance values (up to 1700 Ω), whereas in the other soft tissue sarcomas, such as those originating from muscle, nerve sheath, or fibrous tissue, the electrical resistance measured was between 40 and 110 Ω. A variability in resistance was found also within the same histotype. Among lipomatous tumors, the presence of myxoid tissue between adipocytes reduced the electrical resistance (e.g., 50-100 Ω). This work represents the first step in order to explore the difference in tissue electrical properties of STS. These results may be used to verify whether tuning electric field intensity according to the specific STS histotype could improve tissue electroporation and ultimately treatment efficacy.
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Affiliation(s)
- L G Campana
- Sarcoma and Melanoma Unit, Veneto Institute of Oncology IOV IRCCS, Via Gattamelata, 64, 35128, Padua, Italy
| | - M Cesari
- Department of Industrial Engineering, University of Padova, Via Gradenigo, 6/a, 35131, Padua, Italy
| | - F Dughiero
- Department of Industrial Engineering, University of Padova, Via Gradenigo, 6/a, 35131, Padua, Italy
| | - M Forzan
- Department of Industrial Engineering, University of Padova, Via Gradenigo, 6/a, 35131, Padua, Italy
| | - M Rastrelli
- Sarcoma and Melanoma Unit, Veneto Institute of Oncology IOV IRCCS, Via Gattamelata, 64, 35128, Padua, Italy
| | - C R Rossi
- Sarcoma and Melanoma Unit, Veneto Institute of Oncology IOV IRCCS, Via Gattamelata, 64, 35128, Padua, Italy
| | - E Sieni
- Department of Industrial Engineering, University of Padova, Via Gradenigo, 6/a, 35131, Padua, Italy.
| | - A L Tosi
- Melanoma and Sarcoma Pathology Unit, Veneto Institute of Oncology IOV IRCCS, Via Gattamelata, 64, 35128, Padua, Italy
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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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Mercantini P, Lorenzon L, Tarantino G, Balducci G, Ferri M, Mazzuca F, Botticelli A, Marchetti P. Electrochemotherapy Treatment of Cutaneous Metastases from Breast Cancer. Am Surg 2015. [DOI: 10.1177/000313481508100514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Paolo Mercantini
- Surgical and Medical Department of Translational Medicine Rome “La Sapienza”, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Laura Lorenzon
- Surgical and Medical Department of Translational Medicine Rome “La Sapienza”, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Giulia Tarantino
- Surgical and Medical Department of Translational Medicine Rome “La Sapienza”, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Genoveffa Balducci
- Surgical and Medical Department of Translational Medicine Rome “La Sapienza”, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Mario Ferri
- Surgical and Medical Department of Translational Medicine Rome “La Sapienza”, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Federica Mazzuca
- Department of Clinical and Molecular Medicine Faculty of Medicine and Psychology University of Rome “La Sapienza”, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Andrea Botticelli
- Department of Clinical and Molecular Medicine Faculty of Medicine and Psychology University of Rome “La Sapienza”, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine Faculty of Medicine and Psychology University of Rome “La Sapienza”, Sant'Andrea Hospital of Rome, Rome, Italy
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Ongaro A, Campana LG, De Mattei M, Dughiero F, Forzan M, Pellati A, Rossi CR, Sieni E. Evaluation of the Electroporation Efficiency of a Grid Electrode for Electrochemotherapy: From Numerical Model to In Vitro Tests. Technol Cancer Res Treat 2015; 15:296-307. [PMID: 25911645 DOI: 10.1177/1533034615582350] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/02/2015] [Indexed: 12/21/2022] Open
Abstract
Electrochemotherapy (ECT) is a local anticancer treatment based on the combination of chemotherapy and short, tumor-permeabilizing, voltage pulses delivered using needle electrodes or plate electrodes. The application of ECT to large skin surface tumors is time consuming due to technical limitations of currently available voltage applicators. The availability of large pulse applicators with few and more spaced needle electrodes could be useful in the clinic, since they could allow managing large and spread tumors while limiting the duration and the invasiveness of the procedure. In this article, a grid electrode with 2-cm spaced needles has been studied by means of numerical models. The electroporation efficiency has been assessed on human osteosarcoma cell line MG63 cultured in monolayer. The computational results show the distribution of the electric field in a model of the treated tissue. These results are helpful to evaluate the effect of the needle distance on the electric field distribution. Furthermore, the in vitro tests showed that the grid electrode proposed is suitable to electropore, by a single application, a cell culture covering an area of 55 cm(2). In conclusion, our data might represent substantial improvement in ECT in order to achieve a more homogeneous and time-saving treatment, with benefits for patients with cancer.
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Affiliation(s)
- A Ongaro
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - L G Campana
- Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - M De Mattei
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - F Dughiero
- Department of Industrial Engineering, University of Padova, Padova, Italy
| | - M Forzan
- Department of Industrial Engineering, University of Padova, Padova, Italy
| | - A Pellati
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - C R Rossi
- Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - E Sieni
- Department of Industrial Engineering, University of Padova, Padova, Italy
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Cemazar M, Todorovic V, Scancar J, Lampreht U, Stimac M, Kamensek U, Kranjc S, Coer A, Sersa G. Adjuvant TNF-α therapy to electrochemotherapy with intravenous cisplatin in murine sarcoma exerts synergistic antitumor effectiveness. Radiol Oncol 2015; 49:32-40. [PMID: 25810699 PMCID: PMC4362604 DOI: 10.1515/raon-2015-0005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 01/15/2015] [Indexed: 12/16/2022] Open
Abstract
Background Electrochemotherapy is a tumour ablation modality, based on electroporation of the cell membrane, allowing non-permeant anticancer drugs to enter the cell, thus augmenting their cytotoxicity by orders of magnitude. In preclinical studies, bleomycin and cisplatin proved to be the most suitable for clinical use. Intravenous administration of cisplatin for electrochemotherapy is still not widely accepted in the clinics, presumably due to its lower antitumor effectiveness, but adjuvant therapy by immunomodulatory or vascular-targeting agents could provide a way for its potentiation. Hence, the aim of the present study was to explore the possibility of adjuvant tumour necrosis factor α (TNF-α) therapy to potentiate antitumor effectiveness of electrochemotherapy with intravenous cisplatin administration in murine sarcoma. Materials and methods In vivo study was designed to evaluate the effect of TNF-α applied before or after the electrochemotherapy and to evaluate the effect of adjuvant TNF-α on electrochemotherapy with different cisplatin doses. Results A synergistic interaction between TNF-α and electrochemotherapy was observed. Administration of TNF-α before the electrochemotherapy resulted in longer tumour growth delay and increased tumour curability, and was significantly more effective than TNF-α administration after the electrochemotherapy. Tumour analysis revealed increased platinum content in tumours, TNF-α induced blood vessel damage and increased tumour necrosis after combination of TNF-α and electrochemotherapy, indicating an anti-vascular action of TNF-α. In addition, immunomodulatory effect might have contributed to curability rate of the tumours. Conclusion Adjuvant intratumoural TNF-α therapy synergistically contributes to electrochemotherapy with intravenous cisplatin administration. Due to its potentiation at all doses of cisplatin, the combined treatment is predicted to be effective also in tumours, where the drug concentration is suboptimal or in bigger tumours, where electrochemotherapy with intravenous cisplatin is not expected to be sufficiently effective.
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Affiliation(s)
- Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
- Correspondence to: Dr. Maja Čemažar and Dr. Gregor Serša, Institute of Oncology Ljubljana, Department of Experimental Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia. Phone +386 1 587 95 44; Fax: +386 1 587 94 34; E-mail: or
| | - Vesna Todorovic
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Ursa Lampreht
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Monika Stimac
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Urska Kamensek
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Simona Kranjc
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Andrej Coer
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Correspondence to: Dr. Maja Čemažar and Dr. Gregor Serša, Institute of Oncology Ljubljana, Department of Experimental Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia. Phone +386 1 587 95 44; Fax: +386 1 587 94 34; E-mail: or
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50
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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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