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De Nardi AB, de Oliveira Massoco Salles Gomes C, Fonseca-Alves CE, de Paiva FN, Linhares LCM, Carra GJU, dos Santos Horta R, Ruiz Sueiro FA, Jark PC, Nishiya AT, de Carvalho Vasconcellos CH, Ubukata R, Batschinski K, Sobral RA, Fernandes SC, Biondi LR, De Francisco Strefezzi R, Matera JM, Rangel MMM, dos Anjos DS, Brunner CHM, Laufer-Amorim R, Cadrobbi KG, Cirillo JV, Martins MC, de Paula Reis Filho N, Silva Lessa DF, Portela R, Scarpa Carneiro C, Ricci Lucas SR, Fukumasu H, Feliciano MAR, Gomes Quitzan J, Dagli MLZ. Diagnosis, Prognosis, and Treatment of Canine Hemangiosarcoma: A Review Based on a Consensus Organized by the Brazilian Association of Veterinary Oncology, ABROVET. Cancers (Basel) 2023; 15:cancers15072025. [PMID: 37046686 PMCID: PMC10093745 DOI: 10.3390/cancers15072025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
Hemangiosarcoma is a mesenchymal neoplasm originating in the endothelial cells of blood vessels; they can be classified as non-visceral and visceral types. Non-visceral hemangiosarcomas can affect the skin, subcutaneous tissues, and muscle tissues; visceral hemangiosarcomas can affect the spleen, liver, heart, lungs, kidneys, oral cavity, bones, bladder, uterus, tongue, and retroperitoneum. Among domestic species, dogs are most affected by cutaneous HSA. Cutaneous HSA represents approximately 14% of all HSA diagnosed in this species and less than 5% of dermal tumors, according to North American studies. However, Brazilian epidemiological data demonstrate a higher prevalence, which may represent 27 to 80% of all canine HSAs and 13.9% of all skin neoplasms diagnosed in this species. Cutaneous HSA most commonly affects middle-aged to elderly dogs (between 8 and 15 years old), with no gender predisposition for either the actinic or non-actinic forms. The higher prevalence of cutaneous HSA in some canine breeds is related to lower protection from solar radiation, as low skin pigmentation and hair coverage lead to greater sun exposure. Actinic changes, such as solar dermatosis, are frequent in these patients, confirming the influence of solar radiation on the development of this neoplasm. There are multiple clinical manifestations of hemangiosarcoma in canines. The diagnostic approach and staging classification of cutaneous HSAs are similar between the different subtypes. The definitive diagnosis is obtained through histopathological analysis of incisional or excisional biopsies. Cytology can be used as a presurgical screening test; however, it has little diagnostic utility in cases of HSA because there is a high risk of blood contamination and sample hemodilution. Surgery is generally the treatment of choice for dogs with localized non-visceral HSA without evidence of metastatic disease. Recently, electrochemotherapy (ECT) has emerged as an alternative therapy for the local ablative treatment of different neoplastic types; the use of radiotherapy for the treatment of dogs with cutaneous HSA is uncommon. There is greater consensus in the literature regarding the indications for adjuvant chemotherapy in subcutaneous and muscular HSA; doxorubicin is the most frequently used antineoplastic agent for subcutaneous and muscular subtypes and can be administered alone or in combination with other drugs. Other therapies include antiangiogenic therapy, photodynamic therapy, the association of chemotherapy with the metronomic dose, targeted therapies, and natural products. The benefits of these therapies are presented and discussed. In general, the prognosis of splenic and cardiac HSA is unfavorable. As a challenging neoplasm, studies of new protocols and treatment modalities are necessary to control this aggressive disease.
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Spugnini EP, Baldi A. Electrochemotherapy in Veterinary Oncology: State-of-the-Art and Perspectives. Vet Clin North Am Small Anim Pract 2019; 49:967-979. [PMID: 31176458 DOI: 10.1016/j.cvsm.2019.04.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tumor microenvironment represents a key obstacle for the effectiveness of anticancer drugs. Electrochemotherapy involves the systemic or local delivery of lipophobic drugs such as bleomycin and cisplatin, with the application of permeabilizing electric pulses having appropriate amplitude and waveforms. This greatly enhances the uptake of these drugs by an estimated factor of 700-fold for bleomycin and 4 to 8 times for cisplatin. Because of its efficacy and limited morbidity, this therapeutic option is becoming more and more available in veterinary oncology either as an adjuvant to surgery or as first line of treatment with palliative or curative purposes.
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Affiliation(s)
| | - Alfonso Baldi
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, Campania University "Luigi Vanvitelli", Via Vivaldi, 43, Caserta 81100, Italy
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Torrigiani F, Pierini A, Lowe R, Simčič P, Lubas G. Soft tissue sarcoma in dogs: A treatment review and a novel approach using electrochemotherapy in a case series. Vet Comp Oncol 2019; 17:234-241. [PMID: 30688021 DOI: 10.1111/vco.12462] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 12/17/2022]
Abstract
Canine soft tissue sarcomas (STSs) are locally invasive mesenchymal neoplasms. Electrochemotherapy (ECT) is an antitumour local ablative treatment that uses electric pulses to enhance the intracellular delivery of cytotoxic drugs. The aim of this retrospective study was to review the current treatment for STSs and to evaluate the efficacy and safety of ECT with bleomycin in canine STSs. Fifty-two dogs with 54 STSs were included. Three groups were arranged: (a) ECT alone, (b) intra-operative ECT and (c) adjuvant ECT. Signalment, tumour size, location, histological grade and margins and ECT parameters were collected. Recurrence rate (RR) and disease-free interval (DFI) were calculated. Treatment toxicity was assessed using a 6-point scale. STSs were mostly located on limbs (77.8%). Median tumour size was 4.3 cm (range 0.4-17.0 cm). Most STSs were grade I (47.7%) and II (50.0%), and histological margins were incomplete in 94.5% of cases. Two complete remissions, one partial remission and one stable disease were recorded in group 1. Group 2 and 3 were similar for tumour location, size and grade, histological margins, treatment toxicity, pulse frequency and voltage. Moreover, RR and DFI were similar between group 2 and 3 (23% and 25%, 81.5 and 243 days, respectively). Local toxicity post ECT was mild (score ≤ 2) in 66.7% of cases. Higher toxicity score was associated with higher pulse voltage (1200 vs 1000 V/cm) (P = 0.0473). ECT coupled with bleomycin resulted safe and efficient in tumour local control and should be considered as an option for treatment of canine STSs.
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Affiliation(s)
| | - Alessio Pierini
- Department of Veterinary Sciences, Università di Pisa, Pisa, Italy
| | - Ron Lowe
- Ashleigh Veterinary Clinic, Knaresborough, UK
| | - Petra Simčič
- Department of Veterinary Sciences, Università di Pisa, Pisa, Italy
| | - George Lubas
- Department of Veterinary Sciences, Università di Pisa, Pisa, Italy
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Spugnini EP, Vincenzi B, Amadio B, Baldi A. Adjuvant electrochemotherapy with bleomycin and cisplatin combination for canine soft tissue sarcomas: A study of 30 cases. Open Vet J 2019; 9:88-93. [PMID: 31086772 PMCID: PMC6500853 DOI: 10.4314/ovj.v9i1.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 03/10/2019] [Indexed: 12/25/2022] Open
Abstract
Electrochemotherapy (ECT) couples the administration of anticancer drugs with the delivery of electric pulses that increase the drug uptake through the cell membranes, thus resulting in an improved efficacy. This study has evaluated the tolerability and efficacy of the combination of systemic bleomycin and local cisplatin as ECT agents for incompletely excised canine soft tissue sarcoma (STS). Thirty dogs with incompletely excised STSs were enrolled. The dogs received intravenous 20 mg/m2 bleomycin, and the tumor bed and margins were infiltrated with cisplatin at the dose of 0.5 mg/cm2. Then, trains of permeabilizing biphasic electric pulses were applied under sedation. More precisely, 5 min after the injection of the chemotherapy agents, sequences of eight biphasic pulses lasting 50 + 50 μsec each, were delivered in bursts of 1,300 V/cm using caliper electrodes. A second session was performed 2 wk later. The treatment was well tolerated and side effects were minimal. Twenty-six dogs had no evidence of recurrence at the time of manuscript writing; four had recurrence and one of the four recurring dogs died of lung metastases. Median estimated disease free was 857 d. Perivascular wall tumors response was compared to that of the other STSs, but the difference in outcome was not significant. ECT using combination of bleomycin and cisplatin appears to be effective in the treatment of incompletely resected STSs in dogs. This therapeutic approach could be a useful addition to the current options in consideration of its low cost, limited toxicity, and ease of administration.
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Affiliation(s)
| | - Bruno Vincenzi
- Medical Oncology Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Bruno Amadio
- SAFU service, Regina Elena Cancer Institute, Rome, Italy
| | - Alfonso Baldi
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies Campania University "Luigi Vanvitelli", Caserta, Italy.,Institute of Biosciences and BioResources, CNR, Naples, Italy
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Dos Anjos DS, Rossi YA, Magalhães LF, Calazans SG, Fonseca‐Alves CE. Digital trichoblastoma treated with electrochemotherapy in a dog. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Denner Santos Dos Anjos
- Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Ciencias Agrarias e Veterinarias Campus de JaboticabalJaboticabalBrazil
| | | | | | - Sabryna Gouveia Calazans
- Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Ciencias Agrarias e Veterinarias Campus de JaboticabalJaboticabalBrazil
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Spugnini EP, Fais S, Azzarito T, Baldi A. Novel Instruments for the Implementation of Electrochemotherapy Protocols: From Bench Side to Veterinary Clinic. J Cell Physiol 2016; 232:490-495. [PMID: 27464761 DOI: 10.1002/jcp.25505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 07/27/2016] [Indexed: 01/22/2023]
Abstract
Electrochemotherapy (ECT) is a medical strategy that allows an increased efficacy of chemotherapy agents after the application of permeabilizing electric pulses having appropriate characteristics (form, voltage, frequency). In the past 10 years, the clinical efficacy of this therapeutic approach in several spontaneous models of tumors in animals has been shown. Moreover, some of the molecular and cellular mechanisms responsible for this phenomenon have been elucidated. Our group has been deeply involved in the development of new ECT protocols for companion animals, implementing the use of the technique as first line treatment, and evaluating different chemotherapy agents in laboratory animals as well as pets. This article summarizes the most important advances in veterinary ECT, including the development of novel equipment, therapeutic protocols, and their translation to humans. J. Cell. Physiol. 232: 490-495, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Stefano Fais
- Department of Therapeutic Research and Medicines Evaluation, National Institute of Health, Rome, Italy
| | - Tommaso Azzarito
- Department of Therapeutic Research and Medicines Evaluation, National Institute of Health, Rome, Italy
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Impellizeri J, Aurisicchio L, Forde P, Soden DM. Electroporation in veterinary oncology. Vet J 2016; 217:18-25. [PMID: 27810205 DOI: 10.1016/j.tvjl.2016.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 05/15/2016] [Accepted: 05/28/2016] [Indexed: 12/18/2022]
Abstract
Cancer treatments in veterinary medicine continue to evolve beyond the established standard therapies of surgery, chemotherapy and radiation therapy. New technologies in cancer therapy include a targeted mechanism to open the cell membrane based on electroporation, driving therapeutic agents, such as chemotherapy (electro-chemotherapy), for local control of cancer, or delivery of gene-based products (electro-gene therapy), directly into the cancer cell to achieve systemic control. This review examines electrochemotherapy and electro-gene therapy in veterinary medicine and considers future directions and applications.
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Affiliation(s)
- J Impellizeri
- Veterinary Oncology Services, Hopewell Junction, New York 12533, USA
| | | | - P Forde
- Cork Cancer Research Centre, University College Cork, Ireland
| | - D M Soden
- Cork Cancer Research Centre, University College Cork, Ireland.
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Spugnini EP, Melillo A, Quagliuolo L, Boccellino M, Vincenzi B, Pasquali P, Baldi A. Definition of novel electrochemotherapy parameters and validation of their in vitro and in vivo effectiveness. J Cell Physiol 2014; 229:1177-81. [PMID: 24403005 DOI: 10.1002/jcp.24548] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/20/2013] [Indexed: 12/16/2022]
Abstract
Electrochemotherapy (ECT) is a cancer therapy that conjugates the administration of a chemotherapy agent to the delivery of permeabilizing pulses released singularly or as bursts. This approach results in higher number of anticancer molecules delivered to their biological targets, but is also associated to undesirable side effects such as pain and muscular contractions. A new electroporator delivering train of eight biphasic pulses at the voltage of 1,300 V/cm lasting 50 + 50 µsec each, with a frequency of 1 Hz, and with 10-µsec interpulse intervals (total treatment time: 870 µsec/cm(2) of treated area) was tested in vitro on the human lung cancer cell line A549 and in vivo, both in mice xenografts and privately owned rabbits with spontaneous tumors. The tumor cell line was treated with electroporation using the new parameters, that showed improved drug efficacy in causing cell death. Mice with chemoresistant xenografts were treated as well with either the new parameters and with a previous protocol, confirming the higher tolerability and efficacy of the novel parameters. Finally, a cohort of six pet rabbits with advanced skin neoplasms were enrolled in a compassionate trial using the new parameters in adjuvant fashion. In terms of efficacy, none of the rabbits experienced tumor recurrence, showing minimal discomfort during the ECT sessions. The data described, demonstrate that the new permeabilizing protocol adopting biphasic electric pulses displays a significant higher efficacy compared to previous ECT treatments and substantial reduction of the associated morbidity.
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Spugnini EP, Baldi A. Electrochemotherapy in veterinary oncology: from rescue to first line therapy. Methods Mol Biol 2014; 1121:247-56. [PMID: 24510829 DOI: 10.1007/978-1-4614-9632-8_22] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Electroporation is a delivery technique that is gaining popularity among the veterinary community due to its low cost, ease of application, and flexibility. It combines the administration of pharmaceutical compounds such as chemotherapy agents, antisense, and plasmids to the application of permeabilizing pulses. This chapter reviews the veterinary results obtained through the delivery of anticancer drugs (electrochemotherapy) and genes (electro-gene therapy).
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Spugnini EP, Fanciulli M, Citro G, Baldi A. Preclinical models in electrochemotherapy: the role of veterinary patients. Future Oncol 2012; 8:829-37. [DOI: 10.2217/fon.12.64] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Electrochemotherapy is a tumor treatment that adapts the systemic or local delivery of anticancer drugs by the application of permeabilizing electric pulses with appropriate amplitude and waveforms. This allows the use of lipophobic drugs, which frequently have a narrow therapeutic index, with a decreased morbidity for the patient, while maintaining appropriate anticancer efficacy. Electrochemotherapy is used in humans for the treatment of cutaneous neoplasms or the palliation of skin tumor metastases, and a standard operating procedure has been devised. In veterinary oncology, the electrochemotherapy approach is gaining popularity, becoming a first-line treatment in consideration of its high efficacy and low toxicity. This review summarizes the state of the art in veterinary oncology as a preclinical model.
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Affiliation(s)
| | - Maurizio Fanciulli
- SAFU Department, Regina Elena Cancer Institute, Via delle Messi d’Oro 156, Rome 00158, Italy
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Spugnini EP, Dotsinsky I, Mudrov N, Citro G, D'Avino A, Baldi A. Biphasic pulses enhance bleomycin efficacy in a spontaneous canine genital tumor model of chemoresistance: Sticker sarcoma. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2008; 27:58. [PMID: 18980687 PMCID: PMC2596090 DOI: 10.1186/1756-9966-27-58] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 11/03/2008] [Indexed: 12/21/2022]
Abstract
Sticker's sarcoma (also known as transmissible venereal tumor) is a horizontally transmitted neoplasm of the dog, that is passed with coitus. It is a locally aggressive tumor with a low tendency to metastatic spread. The most common locations are the genitals, the nose, the perianal area. Standard treatment consists with chemotherapy with vincristine, however other therapies such as, cryotherapy, immunotherapy or, in selected cases, radiation therapy, have been reported. In this article we describe the outcome of a small cohort of canine patients, with chemotherapy resistant transmissible venereal tumor (TVT), treated with bleomycin selectively driven by trains of biphasic pulses (electrochemotherapy). Three canine patients, with refractory TVT, entered the study and received two sessions of ECT under sedation. The pets had local injection of bleomycin at the concentration of 1.5 mg/ml and five minutes after the chemotherapy, trains of 8 biphasic electric pulses lasting 50 + 50 μs each, with 1 ms interpulse intervals, were delivered by means of modified caliper or, for difficult districts, through paired needle electrode. All the patients responded to the treatment and are still in remission at different times. Electrochemotherapy appears as a safe and efficacious modality for the treatment of TVT and warrants further investigations.
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Cemazar M, Tamzali Y, Sersa G, Tozon N, Mir LM, Miklavcic D, Lowe R, Teissie J. Electrochemotherapy in veterinary oncology. J Vet Intern Med 2008; 22:826-31. [PMID: 18537879 DOI: 10.1111/j.1939-1676.2008.0117.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Electropermeabilization is a method that uses electric field pulses to induce an electrically mediated reorganization of the plasma membrane of cells. Electrochemotherapy combines local or systemic administration of chemotherapeutic drugs such as bleomycin or cisplatin that have poor membrane permeability with electropermeabilization by direct application of electric pulses to the tumors. Preclinical studies have demonstrated excellent antitumor effectiveness of electrochemotherapy on different animal models and various tumor types, minimal toxicity, and safety of the procedure. Based on results of preclinical studies, clinical studies were conducted in human patients, which demonstrated pronounced antitumor effectiveness of electrochemotherapy with 80-85% objective responses of the treated cutaneous and SC tumors. Clinical studies in veterinary oncology have demonstrated that electrochemotherapy is very effective in the treatment of cutaneous and SC tumors of different histologic types in cats, dogs, and horses. The results of these studies have also demonstrated approximately 80% long-lasting objective responses of tumors treated by electrochemotherapy. Primary tumors of different histologic types were treated. Electrochemotherapy in veterinary oncology has future promise to be highly effective, and could be used to treat primary or recurrent solitary or multiple cutaneous and SC tumors of different histology or as an adjuvant treatment to surgery.
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Affiliation(s)
- M Cemazar
- Institute of Oncology Ljubljana, University of Ljubljana, Ljubljana, Slovenia the Ecole Vétérinaire de Toulouse, Toulouse, France
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