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Fernández-Galván A, Rodríguez-Jiménez P, González-Sixto B, Abalde-Pintos MT, Butrón-Bris B. Topical and Intralesional Immunotherapy for the Management of Basal Cell Carcinoma. Cancers (Basel) 2024; 16:2135. [PMID: 38893254 PMCID: PMC11172323 DOI: 10.3390/cancers16112135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Basal Cell Carcinoma (BCC) is the most common type of cancer among the white population. Individuals with fair skin have an average lifetime risk of around 30% for developing BCC, and there is a noticeable upward trend in its incidence rate. The principal treatment objectives for BCC involve achieving the total excision of the tumor while maximizing the preservation of function and cosmesis. Surgery is considered the treatment of choice for BCC for two main reasons: it allows for the highest cure rates and facilitates histological control of resection margins. However, in the subgroup of patients with low-risk recurrence or medical contraindications for surgery, new non-surgical treatment alternatives can provide an excellent oncological and cosmetic outcome. An evident and justified instance of these local therapies occurred during the COVID-19 pandemic, a period when surgical interventions carried out in hospital settings were not a viable option.
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Affiliation(s)
- Aurora Fernández-Galván
- Dermatology Department, Hospital Universitario La Princesa, Diego de León St. 62, 28006 Madrid, Spain; (A.F.-G.); (B.B.-B.)
| | - Pedro Rodríguez-Jiménez
- Dermatology Department, Hospital Universitario La Princesa, Diego de León St. 62, 28006 Madrid, Spain; (A.F.-G.); (B.B.-B.)
- Dermatology Department, Hospital Ruber Internacional, 28034 Madrid, Spain
| | - Beatriz González-Sixto
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain; (B.G.-S.); (M.T.A.-P.)
| | - María Teresa Abalde-Pintos
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain; (B.G.-S.); (M.T.A.-P.)
| | - Beatriz Butrón-Bris
- Dermatology Department, Hospital Universitario La Princesa, Diego de León St. 62, 28006 Madrid, Spain; (A.F.-G.); (B.B.-B.)
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2
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Queirolo P, Cinquini M, Argenziano G, Bassetto F, Bossi P, Boutros A, Clemente C, de Giorgi V, Del Vecchio M, Patuzzo R, Peris K, Quaglino P, Reali A, Zalaudek I, Spagnolo F. Guidelines for the diagnosis and treatment of basal cell carcinoma: a GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. ESMO Open 2023; 8:102037. [PMID: 37879235 PMCID: PMC10598491 DOI: 10.1016/j.esmoop.2023.102037] [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: 05/29/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common form of cancer, with a high impact on the public health burden and social costs. Despite the overall prognosis for patients with BCC being excellent, if lesions are allowed to progress, or in a small subset of cases harboring an intrinsically aggressive biological behavior, it can result in local spread and significant morbidity, and conventional treatments (surgery and radiotherapy) may be challenging. When a BCC is not amenable to either surgery or radiotherapy with a reasonable curative intent, or when metastatic spread occurs, systemic treatments with Hedgehog inhibitors are available. These guidelines were developed, applying the GRADE approach, on behalf of the Italian Association of Medical Oncologists (AIOM) to assist clinicians in treating patients with BCC. They contain recommendations with regard to the diagnosis, treatment and follow-up, from primitive tumors to those locally advanced or metastatic, addressing the aspects of BCC management considered as priorities by a panel of experts selected by AIOM and other national scientific societies. The use of these guidelines in everyday clinical practice should improve patient care.
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Affiliation(s)
- P Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - G Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples
| | - F Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua
| | - P Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia
| | - A Boutros
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa
| | - C Clemente
- UO SMEL-2, Surgical Pathology, Department of Pathology and Laboratory Medicine, IRCCS-Policlinico San Donato, Milan
| | - V de Giorgi
- Dermatology Unit, Azienda USL Toscana Centro, Florence; Section of Dermatology, Department of Health Sciences, University of Florence, Florence
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Patuzzo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Unit, Milan
| | - K Peris
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - P Quaglino
- Department of Medical Sciences, Clinic of Dermatology, University of Turin, Turin
| | - A Reali
- Radiation Oncology Department, Michele e Pietro Ferrero Hospital, Verduno
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste
| | - F Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy.
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McMillan AT, McElroy L, O'Toole L, Matteucci P, Totty JP. Electrochemotherapy vs radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases from primary solid organ malignancies: A systematic review and narrative synthesis. PLoS One 2023; 18:e0288251. [PMID: 37440502 PMCID: PMC10343145 DOI: 10.1371/journal.pone.0288251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Electrochemotherapy has gained international traction and commendation in national guidelines as an effective tool in the management of cutaneous malignancies not amenable to surgical resection. Despite this, no level 5 evidence exists comparing it to radiotherapy in the treatment of cutaneous malignancies. This systematic review aimed to examine the literature directly and indirectly comparing electrochemotherapy and radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases from primary solid organ malignancies. MATERIALS & METHODS The protocol for this review was registered on the PROSPERO International Prospective Register of Systematic Reviews with the protocol ID CRD42021285415. Searches of MEDLINE, Embase, CINAHL, CENTRAL and ClinicalTrials.gov databases were undertaken from database inception to 28 December 2021. Studies in humans comparing treatment with electrochemotherapy to radiotherapy and reporting tumour response with a minimum four week follow-up were eligible. Risk of bias was assessed using the ROBINS-I tool. Results are provided as a narrative synthesis. RESULTS Two case series with a total of 92 patients were identified as relevant to this study. Both case series examined patients with cutaneous squamous cell carcinoma. One case series examined elderly patients with predominantly head/neck lesions. The other examined younger patients with predominantly limb lesions who had cutaneous squamous cell carcinoma directly attributable to a rare skin condition. CONCLUSION There is little literature presenting comparative data for electrochemotherapy and radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases. Included studies were marred by serious risk of bias particularly due to confounding. The inherent bias and heterogeneity of the included studies precluded synthesis of a consolidated comparison of clinical outcomes between the two therapies. Further research is required in this domain in the form of clinical trials and observational studies to inform guidelines for electrochemotherapy treatment.
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Affiliation(s)
- Angus Torry McMillan
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, United Kingdom
| | - Luke McElroy
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, United Kingdom
| | - Lorcan O'Toole
- Department of Oncology, Hull University Teaching Hospitals NHS Trust, Cottingham, United Kingdom
| | - Paolo Matteucci
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, United Kingdom
| | - Joshua Philip Totty
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
- University of Hull, Cottingham Road, Hull, United Kingdom
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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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Lyons P, Polini D, Russell-Ryan K, Clover AJP. High-Frequency Electroporation and Chemotherapy for the Treatment of Cutaneous Malignancies: Evaluation of Early Clinical Response. Cancers (Basel) 2023; 15:3212. [PMID: 37370822 DOI: 10.3390/cancers15123212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/28/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
High-frequency electroporation (HF-EP) with chemotherapy is a novel therapy proposed for both curative and palliative treatment of cutaneous malignancies. The use of high-frequency biphasic pulses is thought to reduce the painful muscle contractions associated with traditional electrochemotherapy (ECT), allowing treatment administration under local anaesthesia. This proof-of-concept study investigated the efficacy and tolerability of HF-EP protocols on a variety of cutaneous malignancies. A total of 97 lesions of five different histological subtypes were treated across 25 patients. At 12 weeks post-treatment, a 91.3% overall lesion response rate was observed (complete response: 79%; partial response: 12.3%), with excellent intraprocedural patient tolerability under local anaesthetic. HF-EP with chemotherapy shows promising results regarding tumour response rates for cutaneous malignancies of varying histological subtypes when compared to traditional ECT protocols. Improved patient tolerability is important, increasing the possibility of treatment delivery under local anaesthesia and potentially broadening the treatment envelope for patients with cutaneous malignancies.
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Affiliation(s)
- Phoebe Lyons
- Department of Plastic Surgery, Cork University Hospital, T12 DC4A Cork, Ireland
| | - Dana Polini
- School of Medicine, University College Cork, T12 YN60 Cork, Ireland
| | | | - A James P Clover
- Department of Plastic Surgery, Cork University Hospital, T12 DC4A Cork, Ireland
- Cancer Research@UCC, University College Cork, T12 YN60 Cork, Ireland
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Benedik J, Ogorevc B, Brezar SK, Cemazar M, Sersa G, Groselj A. Comparison of general anesthesia and continuous intravenous sedation for electrochemotherapy of head and neck skin lesions. Front Oncol 2022; 12:1011721. [PMID: 36465339 PMCID: PMC9717680 DOI: 10.3389/fonc.2022.1011721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2022] Open
Abstract
BackgroundElectrochemotherapy of cutaneous tumor nodules requires local or general anesthesia. For multiple and larger nodules, general anesthesia is recommended by standard operating procedures. The choice of general anesthesia is at the discretion of the treating center. Continuous intravenous sedation is also an option. Our study aimed to elucidate the tolerability, safety and possible advantages of continuous intravenous sedation in comparison to general anesthesia in patients undergoing electrochemotherapy.Patients and methodsIn the prospective study, 27 patients undergoing electrochemotherapy were either under general anesthesia or under continuous intravenous sedation. Evaluated were different endpoints, such as feasibility and safety, duration of anesthesia and compliance with the patients.ResultsTen patients were treated under general anesthesia, and 17 patients were under continuous intravenous sedation. The comparison of the approaches indicated that continuous intravenous sedation required a lower overall dosage of propofol, a shorter duration of anesthesia, a shorter time to reach an Aldrete score >8, and greater satisfaction of the patients with the procedure compared to general anesthesia.ConclusionThe results indicate the feasibility and safety of continuous intravenous sedation for patients undergoing electrochemotherapy of cutaneous tumor nodules. This proved the preferred choice of anesthesia due to its shorter duration and better compliance with the patients compared to general anesthesia.
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Affiliation(s)
- Janez Benedik
- Department of Anesthesiology and Perioperative Intensive Care Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Ogorevc
- Department of Anesthesiology and Perioperative Intensive Care Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Simona Kranjc Brezar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Ales Groselj, ; Gregor Sersa,
| | - Ales Groselj
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- *Correspondence: Ales Groselj, ; Gregor Sersa,
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Tasu JP, Tougeron D, Rols MP. Irreversible electroporation and electrochemotherapy in oncology: State of the art. Diagn Interv Imaging 2022; 103:499-509. [DOI: 10.1016/j.diii.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 01/10/2023]
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8
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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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Bertino G, Muir T, Odili J, Groselj A, Marconato R, Curatolo P, Kis E, Lonkvist CK, Clover J, Quaglino P, Kunte C, Spina R, Seccia V, de Terlizzi F, Campana LG. Treatment of Basal Cell Carcinoma with Electrochemotherapy: Insights from the InspECT Registry (2008–2019). Curr Oncol 2022; 29:5324-5337. [PMID: 36005161 PMCID: PMC9406883 DOI: 10.3390/curroncol29080423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
This prospective registry-based study aims to describe electrochemotherapy (ECT) modalities in basal cell carcinoma (BCC) patients and evaluate its efficacy, safety, and predictive factors. The International Network for Sharing Practices of Electrochemotherapy (InspECT) multicentre database was queried for BCC cases treated with bleomycin-ECT between 2008 and 2019 (n = 330 patients from seven countries, with 623 BCCs [median number: 1/patient; range: 1–7; size: 13 mm, range: 5–350; 85% were primary, and 80% located in the head and neck]). The procedure was carried out under local anaesthesia in 68% of cases, with the adjunct of mild sedation in the remaining 32%. Of 300 evaluable patients, 242 (81%) achieved a complete response (CR) after a single ECT course. Treatment naïvety (odds ratio [OR] 0.35, 95% confidence interval [C.I.] 0.19–0.67, p = 0.001) and coverage of deep tumour margin with electric pulses (O.R. 5.55, 95% C.I. 1.37–21.69, p = 0.016) predicted CR, whereas previous radiation was inversely correlated (O.R. 0.25, p = 0.0051). Toxicity included skin ulceration (overall, 16%; G3, 1%) and hyperpigmentation (overall, 8.1%; G3, 2.5%). At a 17-month follow-up, 28 (9.3%) patients experienced local recurrence/progression. Despite no convincing evidence that ECT confers improved outcomes compared with standard surgical excision, it can still be considered an opportunity to avoid major resection in patients unsuitable for more demanding treatment. Treatment naïvety and coverage of the deep margin predict tumour clearance and may inform current patient selection and management.
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Affiliation(s)
- Giulia Bertino
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
| | - Tobian Muir
- South Tees NHS Foundation Trust, Middlesbrough TS4 3BW, UK;
| | - Joy Odili
- Department of Plastic Surgery, St. George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK;
| | - Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia;
| | | | - Pietro Curatolo
- Dermatology Unit, Department of Internal Medicine and Medical Specialties, University “La Sapienza”, 00042 Rome, Italy;
| | - Erika Kis
- Department of Dermatology and Allergology, Albert Szent-Györgyi Clinical Centre, University of Szeged, 6700 Szeged, Hungary;
| | - Camilla Kjaer Lonkvist
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark;
| | - James Clover
- Cork Cancer Research Centre, University College Cork, T12 YN60 Cork, Ireland;
- Department of Plastic Surgery, Cork University Hospital, T12 DC4A Cork, Ireland
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10094 Turin, Italy;
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik München, 81379 Munich, Germany;
- Department of Dermatology and Allergology, Ludwig-Maximillian University, 80539 Munich, Germany
| | - Romina Spina
- Psychology Unit, University Hospital of Padova, 35100 Padova, Italy;
| | - Veronica Seccia
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy;
| | - Francesca de Terlizzi
- IGEA Clinical Biophysics Department, Via Parmenide 10/A, Carpi, 41012 Modena, Italy;
| | - Luca Giovanni Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, UK
- Correspondence:
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Fania L, Samela T, Moretta G, Ricci F, Dellambra E, Mancini M, Sampogna F, Panebianco A, Abeni D. Attitudes among dermatologists regarding non-melanoma skin cancer treatment options. Discov Oncol 2021; 12:31. [PMID: 35201447 PMCID: PMC8777506 DOI: 10.1007/s12672-021-00421-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/04/2021] [Indexed: 12/27/2022] Open
Abstract
Non-melanoma skin cancers include basal and squamous cell carcinoma. These tumors have become an important health issue for their high incidence and for the morbidity, especially if untreated for a long period. Over the last 20 years, therapeutic approaches for these tumours have been improved and tailored. In this survey we provided data from one hundred and ten Italian dermatologists regarding knowledge and attitude towards different therapeutic approaches on non-melanoma skin cancers. In our study, we observed that surgery and imiquimod 5% cream were the most used treatment by dermatologists for basal cell carcinoma, while, surgery was the most common treatment for cutaneous squamous cell carcinoma. Furthermore, we observed some differences regarding the prescribed therapies in the different Italian geographical areas (i.e., Mohs' surgery and electrochemotherapy were more frequently used in Northern compared to Central and Southern Italy whereas immunotherapy was more used in Southern compared to Northern and Central Italy) and even considering the year of specialization of the dermatologists (i.e., immunotherapy with cemiplimab was prescribed mainly by dermatologists with 10-19 years of specialization). However, for locally advanced and metastatic forms of basal and squamous cell carcinoma, Hedgehog Pathway Inhibitors and anti- Programmed cell death protein antibody treatment, respectively, were used in line with the newest evolution of therapies regarding this topic. Considering the importance of skin cancers and its progressive increase in incidence, it is crucial to improve the knowledge of different therapeutic approaches among dermatologists.
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Affiliation(s)
- Luca Fania
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167, Rome, Italy.
| | - Tonia Samela
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167, Rome, Italy
| | - Gaia Moretta
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167, Rome, Italy
| | - Francesco Ricci
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167, Rome, Italy
| | - Elena Dellambra
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167, Rome, Italy
| | - Mara Mancini
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167, Rome, Italy
| | - Francesca Sampogna
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167, Rome, Italy
| | - Annarita Panebianco
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167, Rome, Italy
| | - Damiano Abeni
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167, Rome, Italy
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11
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Fania L, Massone C, Cusano F, Fantini F, Dellambra E, Samela T, Passarelli F, Morese R, Tartaglione T, Maggiore M, Gentile P, Falchetto Osti M, Sampogna F, Pallotta S, Abeni D, Marchetti P, Naldi L. Integrated care pathways and the hub-and-spoke model for the management of non-melanoma skin cancer: A proposal of the Italian Association of Hospital Dermatologists (ADOI). Dermatol Reports 2021; 13:9278. [PMID: 34497705 PMCID: PMC8404423 DOI: 10.4081/dr.2021.9278] [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: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 12/26/2022] Open
Abstract
The term non-melanoma skin cancer (NMSC) refers to skin cancer different from melanoma, and it is usually restricted to basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and their pre-cancerous lesions, e.g., actinic keratosis. These conditions represent the most frequent tumors in Caucasians and are characterized by an increasing incidence worldwide and a high socio-economic impact. The term Integrated Care Pathway (ICP) refers to "a complex intervention for the mutual decision making and organization of care processes for a well-defined group of patients during a well-defined period". The purpose of this paper is to present a proposal from the Italian Association of Hospital Dermatologists (ADOI) for an ICP organization of care of NMSC, considering the hub-and-spoke model in the different geographical areas. This proposal is based on the most recent literature and on documents from the Italian Association of Medical Oncology (AIOM), the European consensus-based interdisciplinary guidelines from the European Association of Dermato- Oncology (EADO), and the National Comprehensive Cancer Network (NCCN). We initially discuss the NMSC outpatient clinic, the role of the multidisciplinary working groups, and the hub-and-spoke model regarding this topic. Then, we define the ICP processes specific for BCC and SCC. The ICP for NMSC is an innovative strategy to guarantee the highest possible quality of health care while the hub-andspoke model is crucial for the organization of different health care structures. Considering the importance on this topic, it is essential to create a valid ICP together with an efficient organization within the different geographical areas.
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Affiliation(s)
- Luca Fania
- IDI-IRCCS, Dermatological Research Hospital, Rome
| | | | | | | | | | - Tonia Samela
- IDI-IRCCS, Dermatological Research Hospital, Rome
| | | | | | | | | | - Piercarlo Gentile
- University of Pittsburgh Medical Center, San Pietro Fatebenefratelli, Rome
| | | | | | | | | | | | - Luigi Naldi
- Centro Studi GISED, Bergamo and San Bortolo Hospital, Vicenza, Italy
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12
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Cucu CI, Giurcăneanu C, Popa LG, Orzan OA, Beiu C, Holban AM, Grumezescu AM, Matei BM, Popescu MN, Căruntu C, Mihai MM. Electrochemotherapy and Other Clinical Applications of Electroporation for the Targeted Therapy of Metastatic Melanoma. MATERIALS 2021; 14:ma14143985. [PMID: 34300902 PMCID: PMC8305146 DOI: 10.3390/ma14143985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/10/2021] [Accepted: 07/11/2021] [Indexed: 12/21/2022]
Abstract
Electrochemotherapy (ECT) is an effective bioelectrochemical procedure that uses controlled electrical pulses to facilitate the increase of intracellular concentration of certain substances (electropermeabilization/ reversible electroporation). ECT using antitumor drugs such as bleomycin and cisplatin is a minimally invasive targeted therapy that can be used as an alternative for oncologic patients not eligible for surgery or other standard therapies. Even though ECT is mainly applied as palliative care for metastases, it may also be used for primary tumors that are unresectable due to size and location. Skin neoplasms are the main clinical indication of ECT, the procedure reporting good curative results and high efficiency across all tumor types, including melanoma. In daily practice, there are many cases in which the patient’s quality of life can be significantly improved by a safe procedure such as ECT. Its popularity must be increased because it has a safe profile and minor local adverse reactions. The method can be used by dermatologists, oncologists, and surgeons. The aim of this paper is to review recent literature concerning electrochemotherapy and other clinical applications of electroporation for the targeted therapy of metastatic melanoma.
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Affiliation(s)
- Corina Ioana Cucu
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Călin Giurcăneanu
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
- Correspondence: ; Tel.: +40-727-173-767
| | - Olguța Anca Orzan
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Cristina Beiu
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Alina Maria Holban
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest, 030018 Bucharest, Romania;
- Research Institute of the University of Bucharest, 050657 Bucharest, Romania
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 1-7 Polizu Street, 011061 Bucharest, Romania;
| | - Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 1-7 Polizu Street, 011061 Bucharest, Romania;
| | - Bogdan Mircea Matei
- Department of Biophysics and Cellular Biotechnology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Marius Nicolae Popescu
- Department of Physical and Rehabilitation Medicine, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Constantin Căruntu
- Faculty of Medicine, “Titu Maiorescu” University, 22 Dambrovnicului, 031593 Bucharest, Romania;
| | - Mara Mădălina Mihai
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
- Research Institute of the University of Bucharest, 050657 Bucharest, Romania
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13
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Hendel K, Jemec GBE, Haedersdal M, Wiegell SR. Electrochemotherapy with bleomycin for basal cell carcinomas: a systematic review. J Eur Acad Dermatol Venereol 2021; 35:2208-2215. [PMID: 34219303 DOI: 10.1111/jdv.17492] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/06/2021] [Accepted: 06/17/2021] [Indexed: 01/17/2023]
Abstract
Basal cell carcinoma (BCC) is the most common type of cancer and an increasing incidence stimulates the interest in new treatments such as electrochemotherapy (ECT) with bleomycin. This systematic review focuses on literature from the MEDLINE, Embase, Web of Science, and Cochrane databases. Bleomycin-ECT studies (n = 32) were sorted by the level of evidence adjusted for their BCC data only. The studies included a single randomised controlled trial (RCT), 15 uncontrolled clinical trials, three registry studies, six prospective case series and seven retrospective case series. A Cochrane risk-of-bias assessment of the RCT identified some minor concerns but no predicted risk of bias. The studies were also grouped by bleomycin administration routes: intravenous (n = 14), intralesional (n = 9) and mixed reporting/usage (n = 9). A meta-analysis was not conducted due to the lack of RCTs and the heterogeneity of the included studies. The results of the RCT generally reflected the findings of the other included studies and showed a 92% complete response in 65 bleomycin-ECT-treated BCCs after 2 months, improving to 100% after re-treatment, with a low risk of recurrence. Based on the RCT results and overall data, future studies on BCC treatment with bleomycin-ECT should include large RCTs that compare bleomycin-ECT with standard of care, cost analyses, and clinical feasibility.
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Affiliation(s)
- K Hendel
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - M Haedersdal
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - S R Wiegell
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
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14
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Hendel K, Hansen ACN, Bik L, Bagger C, van Doorn MBA, Janfelt C, Olesen UH, Haedersdal M, Lerche CM. Bleomycin administered by laser-assisted drug delivery or intradermal needle-injection results in distinct biodistribution patterns in skin: in vivo investigations with mass spectrometry imaging. Drug Deliv 2021; 28:1141-1149. [PMID: 34121567 PMCID: PMC8205002 DOI: 10.1080/10717544.2021.1933649] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Bleomycin (BLM) is being repositioned in dermato-oncology for intralesional and intra-tumoural use. Although conventionally administered by local needle injections (NIs), ablative fractional lasers (AFLs) can facilitate topical BLM delivery. Adding local electroporation (EP) can augment intracellular uptake in the target tissue. Here, we characterize and compare BLM biodistribution patterns, cutaneous pharmacokinetic profiles, and tolerability in an in vivo pig model following fractional laser-assisted topical drug delivery and intradermal NI, with and without subsequent EP. In vivo pig skin was treated with AFL and topical BLM or NI with BLM, alone or with additional EP, and followed for 1, 2 and 4 h and eventually up to 9 d. BLM biodistribution was assessed by spatiotemporal mass spectrometry imaging. Cutaneous pharmacokinetics were assessed by mass spectrometry quantification and temporal imaging. Tolerability was evaluated by local skin reactions (LSRs) and skin integrity measurements. AFL and NI resulted in distinct BLM biodistributions: AFL resulted in a horizontal belt-shaped BLM distribution along the skin surface, and NI resulted in BLM radiating from the injection site. Cutaneous pharmacokinetic analyses and temporal imaging showed a substantial reduction in BLM concentration within the first few hours following administration. LSRs were tolerable overall, and all interventions permitted almost complete recovery of skin integrity within 9 d. In conclusion, AFL and NI result in distinct cutaneous biodistribution patterns and pharmacokinetic profiles for BLM applied to in vivo skin. Evaluation of LSRs showed that both methods were similarly tolerable, and each method has potential for individualized approaches in a clinical setting.
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Affiliation(s)
- Kristoffer Hendel
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anders C N Hansen
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Liora Bik
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Dermatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Charlotte Bagger
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christian Janfelt
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Uffe H Olesen
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
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15
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Nasr I, McGrath EJ, Harwood CA, Botting J, Buckley P, Budny PG, Fairbrother P, Fife K, Gupta G, Hashme M, Hoey S, Lear JT, Mallipeddi R, Mallon E, Motley RJ, Newlands C, Newman J, Pynn EV, Shroff N, Slater DN, Exton LS, Mohd Mustapa MF, Ezejimofor MC. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. Br J Dermatol 2021; 185:899-920. [PMID: 34050920 DOI: 10.1111/bjd.20524] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Affiliation(s)
- I Nasr
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - E J McGrath
- Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - C A Harwood
- Barts Health NHS Trust, London, E1 1BB, UK.,National Cancer Research Institute's Skin Cancer Clinical Studies Group and Non-Melanoma Skin Cancer Subgroup, London, UK
| | - J Botting
- Royal College of General Practitioners, London, UK
| | - P Buckley
- Independent Cancer Patients' Voice, London, UK
| | - P G Budny
- British Association of Plastic, Reconstructive & Aesthetic Surgeons, London, UK.,Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | | | - K Fife
- Royal College of Radiologists, London, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - G Gupta
- NHS Lothian, Lauriston Building, Edinburgh, EH3 9EN, UK
| | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - S Hoey
- Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - J T Lear
- British Society for Skin Care in Immunosuppressed Individuals, London, UK.,Salford Royal NHS Foundation Hospital, Salford, M6 8HD, UK.,Manchester Academic Health Science Centre, Manchester, M20 2LR, UK
| | - R Mallipeddi
- British Society for Dermatological Surgery, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - E Mallon
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - R J Motley
- University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - C Newlands
- British Association of Oral and Maxillofacial Surgeons, London, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - J Newman
- British Dermatological Nursing Group, Belfast, Ireland.,King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - E V Pynn
- Nevill Hall Hospital, Abergavenny, NP7 7EG, UK
| | - N Shroff
- Primary Care Dermatology Society, Rickmansworth, UK
| | - D N Slater
- Royal College of Pathologists, London, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M C Ezejimofor
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
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16
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Brloznik M, Kranjc Brezar S, Boc N, Knific T, Cemazar M, Milevoj N, Sersa G, Tozon N, Pavlin D. Results of Dynamic Contrast-Enhanced Ultrasound Correlate With Treatment Outcome in Canine Neoplasia Treated With Electrochemotherapy and Interleukin-12 Plasmid Electrotransfer. Front Vet Sci 2021; 8:679073. [PMID: 34095282 PMCID: PMC8173043 DOI: 10.3389/fvets.2021.679073] [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: 03/10/2021] [Accepted: 04/09/2021] [Indexed: 12/21/2022] Open
Abstract
Electrochemotherapy (ECT) and/or gene electrotransfer of plasmid DNA encoding interleukin-12 (GET pIL-12) are effective treatments for canine cutaneous, subcutaneous, and maxillofacial tumors. Despite the clinical efficacy of the combined treatments of ECT and GET, data on parameters that might predict the outcome of the treatments are still lacking. This study aimed to investigate whether dynamic contrast-enhanced ultrasound (DCE-US) results of subcutaneous tumors differ between tumors with complete response (CR) and tumors without complete response (non-CR) in dogs treated with ECT and GET pIL-12. Eight dogs with a total of 12 tumor nodules treated with ECT and GET pIL-12 were included. DCE-US examinations were performed in all animals before and immediately after therapy as well as 8 h and 1, 3, and 7 days later. Clinical follow-up examinations were performed 7 and 14 days, 1 and 6 months, and 1 year after treatment. Numerous significant differences in DCE-US parameters were noted between tumors with CR and non-CR tumors; perfusion and perfusion heterogeneity were lower in CR tumors than in non-CR tumors. Therefore, studies with larger numbers of patients are needed to investigate whether DCE-US results can be used to predict treatment outcomes and to make effective decisions about the need for repeated therapy or different treatment combinations in individual patients.
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Affiliation(s)
- Maja Brloznik
- Veterinary Faculty, Small Animal Clinic, University of Ljubljana, Ljubljana, Slovenia
| | - Simona Kranjc Brezar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Boc
- Department of Radiology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Tanja Knific
- Institute of Food Safety, Feed and Environment, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Nina Milevoj
- Veterinary Faculty, Small Animal Clinic, University of Ljubljana, Ljubljana, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Natasa Tozon
- Veterinary Faculty, Small Animal Clinic, University of Ljubljana, Ljubljana, Slovenia
| | - Darja Pavlin
- Veterinary Faculty, Small Animal Clinic, University of Ljubljana, Ljubljana, Slovenia
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17
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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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18
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Advancements in cancer chemotherapy. PHYSICAL SCIENCES REVIEWS 2021. [DOI: 10.1515/psr-2020-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Chemotherapy is in most cases a method of systemic treatment of malignant tumors with cytostatic drugs. Although modern methods such as immunotherapy or targeted therapy are used more and more often nowadays, the role of chemotherapy in oncology is still significant. It can be used as an independent treatment method or in combination with other oncological therapies. The action of chemotherapy is closely linked to the cell cycle of the tumor. Advances in technology allow the introduction of different pharmaceutical forms of the same drug. Worse prognosis of metastatic tumors justifies the need to search for new, more effective treatment methods. The main problem of chemotherapy is the occurrence of adverse events. Reducing the frequency and severity of side effects is possible primarily by changing the technique of implementation of chemotherapy administration. These principles are fulfilled by new, increasingly popular therapeutic methods, such as: Perioperative Hyperthermic Intraperitoneal Chemotherapy (HIPEC), Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) or transarterial chemoembolization (TACE). The dynamic development of knowledge concerning cytostatic drugs, including targeting the tumor cell with the form of the drug, allows us to assume that in the future this direction will increase the effectiveness and safety of anticancer therapy.
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19
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Lyons P, Kennedy A, Clover AJP. Electrochemotherapy and basal cell carcinomas: First-time appraisal of the efficacy of electrochemotherapy on survivorship using FACE-Q. JPRAS Open 2020; 27:119-128. [PMID: 33490356 PMCID: PMC7809247 DOI: 10.1016/j.jpra.2020.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction The establishment and success of new treatments are significantly influenced by patient satisfaction. Post-operative scarring is an important outcome for patients, and subsequently influences overall satisfaction with treatment. The objective was to measure post-treatment scarring satisfaction using a novel scale, the FACE-Q Skin Cancer Module, to compare electrochemotherapy (ECT) to traditional surgical excision (SE) to demonstrate equivalence of ECT and SE regarding outcome and survivorship. Methods and materials This was a multicentre first-time appraisal study of the efficacy of ECT. All patients with facial BCCs treated with either ECT or SE were deemed eligible and subsequently recruited from either a previous clinical trial or outpatient clinics, respectively. Of the 40 participants invited, 25 responses were received. Patient information recorded included age, gender, location and size of BCCs, and time since treatment. Patient outcomes were measured using the FACE-Q Skin Cancer Module. Results The ECT and SE groups consisted of 14 and 11 patients, respectively. Mean age was 68 years (M:F = 16:9), while mean time since treatment was 4.98 years (range 0.3–9.58 years). Appraisal of scars was significantly higher in the ECT cohort versus SE (p = 0.034). Cancer worry was equivalent across both cohorts (p = 0.804). According to treatment type, no correlation was detected between time since treatment and both appraisal of scars (ECT p = 0.466 and SE p = 0.214) and adverse effects (ECT p = 0.924 and SE p = 0.139). Conclusion Based on this study, ECT has superior scar outcomes and overall equivalence to SE. This demonstrates high patient satisfaction for those treated with ECT without any additional cancer worry.
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Affiliation(s)
- Phoebe Lyons
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - Alison Kennedy
- Cancer Research @ UCC, Western Gateway Building, University College Cork, Ireland
| | - A James P Clover
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland.,Cancer Research @ UCC, Western Gateway Building, University College Cork, Ireland
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20
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Thomson J, Hogan S, Leonardi-Bee J, Williams HC, Bath-Hextall FJ. Interventions for basal cell carcinoma of the skin. Cochrane Database Syst Rev 2020; 11:CD003412. [PMID: 33202063 PMCID: PMC8164471 DOI: 10.1002/14651858.cd003412.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the commonest cancer affecting white-skinned individuals, and worldwide incidence is increasing. Although rarely fatal, BCC is associated with significant morbidity and costs. First-line treatment is usually surgical excision, but alternatives are available. New published studies and the development of non-surgical treatments meant an update of our Cochrane Review (first published in 2003, and previously updated in 2007) was timely. OBJECTIVES To assess the effects of interventions for BCC in immunocompetent adults. SEARCH METHODS We updated our searches of the following databases to November 2019: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and LILACS. SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions for BCC in immunocompetent adults with histologically-proven, primary BCC. Eligible comparators were placebo, active treatment, other treatments, or no treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Primary outcome measures were recurrence at three years and five years (measured clinically) (we included recurrence data outside of these time points if there was no measurement at three or five years) and participant- and observer-rated good/excellent cosmetic outcome. Secondary outcomes included pain during and after treatment, early treatment failure within six months, and adverse effects (AEs). We used GRADE to assess evidence certainty for each outcome. MAIN RESULTS We included 52 RCTs (26 new) involving 6690 participants (median 89) in this update. All studies recruited from secondary care outpatient clinics. More males than females were included. Study duration ranged from six weeks to 10 years (average 13 months). Most studies (48/52) included only low-risk BCC (superficial (sBCC) and nodular (nBCC) histological subtypes). The majority of studies were at low or unclear risk of bias for most domains. Twenty-two studies were industry-funded: commercial sponsors conducted most of the studies assessing imiquimod, and just under half of the photodynamic therapy (PDT) studies. Overall, surgical interventions have the lowest recurrence rates. For high-risk facial BCC (high-risk histological subtype or located in the facial 'H-zone' or both), there may be slightly fewer recurrences with Mohs micrographic surgery (MMS) compared to surgical excision (SE) at three years (1.9% versus 2.9%, respectively) (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.16 to 2.64; 1 study, 331 participants; low-certainty evidence) and at five years (3.2% versus 5.2%, respectively) (RR 0.61, 95% CI 0.18 to 2.04; 1 study, 259 participants; low-certainty evidence). However, the 95% CI also includes the possibility of increased risk of recurrence and no difference between treatments. There may be little to no difference regarding improvement of cosmetic outcomes between MMS and SE, judged by participants and observers 18 months post-operatively (one study; low-certainty evidence); however, no raw data were available for this outcome. When comparing imiquimod and SE for nBCC or sBCC at low-risk sites, imiquimod probably results in more recurrences than SE at three years (16.4% versus 1.6%, respectively) (RR 10.30, 95% CI 3.22 to 32.94; 1 study, 401 participants; moderate-certainty evidence) and five years (17.5% versus 2.3%, respectively) (RR 7.73, 95% CI 2.81 to 21.3; 1 study, 383 participants; moderate-certainty evidence). There may be little to no difference in the number of participant-rated good/excellent cosmetic outcomes (RR 1.00, 95% CI 0.94 to 1.06; 1 study, 326 participants; low-certainty evidence). However, imiquimod may result in greater numbers of good/excellent cosmetic outcomes compared to SE when observer-rated (60.6% versus 35.6%, respectively) (RR 1.70, 95% CI 1.35 to 2.15; 1 study, 344 participants; low-certainty evidence). Both cosmetic outcomes were measured at three years. Based on one study of 347 participants with high- and low-risk primary BCC of the face, radiotherapy may result in more recurrences compared to SE under frozen section margin control at three years (5.2% versus 0%, respectively) (RR 19.11, 95% CI 1.12 to 325.78; low-certainty evidence) and at four years (6.4% versus 0.6%, respectively) (RR 11.06, 95% CI 1.44 to 84.77; low-certainty evidence). Radiotherapy probably results in a smaller number of good participant- (RR 0.76, 95% CI 0.63 to 0.91; 50.3% versus 66.1%, respectively) or observer-rated (RR 0.48, 95% CI 0.37 to 0.62; 28.9% versus 60.3%, respectively) good/excellent cosmetic outcomes compared to SE, when measured at four years, where dyspigmentation and telangiectasia can occur (both moderate-certainty evidence). Methyl-aminolevulinate (MAL)-PDT may result in more recurrences compared to SE at three years (36.4% versus 0%, respectively) (RR 26.47, 95% CI 1.63 to 429.92; 1 study; 68 participants with low-risk nBCC in the head and neck area; low-certainty evidence). There were no useable data for measurement at five years. MAL-PDT probably results in greater numbers of participant- (RR 1.18, 95% CI 1.09 to 1.27; 97.3% versus 82.5%) or observer-rated (RR 1.87, 95% CI 1.54 to 2.26; 87.1% versus 46.6%) good/excellent cosmetic outcomes at one year compared to SE (2 studies, 309 participants with low-risk nBCC and sBCC; moderate-certainty evidence). Based on moderate-certainty evidence (single low-risk sBCC), imiquimod probably results in fewer recurrences at three years compared to MAL-PDT (22.8% versus 51.6%, respectively) (RR 0.44, 95% CI 0.32 to 0.62; 277 participants) and five years (28.6% versus 68.6%, respectively) (RR 0.42, 95% CI 0.31 to 0.57; 228 participants). There is probably little to no difference in numbers of observer-rated good/excellent cosmetic outcomes at one year (RR 0.98, 95% CI 0.84 to 1.16; 370 participants). Participant-rated cosmetic outcomes were not measured for this comparison. AEs with surgical interventions include wound infections, graft necrosis and post-operative bleeding. Local AEs such as itching, weeping, pain and redness occur frequently with non-surgical interventions. Treatment-related AEs resulting in study modification or withdrawal occurred with imiquimod and MAL-PDT. AUTHORS' CONCLUSIONS Surgical interventions have the lowest recurrence rates, and there may be slightly fewer recurrences with MMS over SE for high-risk facial primary BCC (low-certainty evidence). Non-surgical treatments, when used for low-risk BCC, are less effective than surgical treatments, but recurrence rates are acceptable and cosmetic outcomes are probably superior. Of the non-surgical treatments, imiquimod has the best evidence to support its efficacy. Overall, evidence certainty was low to moderate. Priorities for future research include core outcome measures and studies with longer-term follow-up.
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Affiliation(s)
- Jason Thomson
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Sarah Hogan
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, Clinical Sciences Building Phase 2, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Fiona J Bath-Hextall
- Emeritus Professor, Evidence Based Health Care, University of Nottingham, Nottingham, UK
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Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, Bataille V, Del Marmol V, Dummer R, Harwood CA, Hauschild A, Höller C, Haedersdal M, Malvehy J, Middleton MR, Morton CA, Nagore E, Stratigos AJ, Szeimies RM, Tagliaferri L, Trakatelli M, Zalaudek I, Eggermont A, Grob JJ. Response to: Comment on 'Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines'. Eur J Cancer 2020; 140:154-157. [PMID: 32978037 DOI: 10.1016/j.ejca.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria C Fargnoli
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Merete Haedersdal
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Mark R Middleton
- Department of Oncology, University of Oxford, Old Road Campus, Oxford, OX3 9DU, UK
| | | | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Alexander J Stratigos
- 1(st)Department of Dermatology- Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Rolf-Markus Szeimies
- Clinic for Dermatology and Allergology, Klinikum Vest GmbH Teaching Hospital, Recklinghausen, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche Ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | | | - Jean J Grob
- University Department of Dermatology, Marseille, France
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Testori AAE, Kunte C, Clover JAP, Bechara FG, Bertino G. Letter to the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization for Research and Treatment of Cancer on guidelines on basal cell carcinoma. Eur J Cancer 2020; 140:151-153. [PMID: 32962895 DOI: 10.1016/j.ejca.2020.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Christian Kunte
- Past-Chair of InspECT (International Network for Sharing Practices on Electrochemotherapy), Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik München GmbH & Co. KG, München, Germany.
| | - James A P Clover
- Chair of InspECT (International Network for Sharing Practices on Electrochemotherapy) and Department of Plastic Surgery, Cork University Hospital, Cork and Cancer Research @UCC, University College Cork, Cork, Ireland.
| | - Falk G Bechara
- Department of Dermatologic Surgery, St. Josef Hospital, Ruhr-University Bochum, Germany.
| | - Giulia Bertino
- Department of Otolaryngology Head and Neck Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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23
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Fabrizio T, Cagiano L, De Terlizzi F, Grieco MP. Neoadjuvant treatment by ECT in cutaneous malignant neoplastic lesions. J Plast Reconstr Aesthet Surg 2020; 73:904-912. [DOI: 10.1016/j.bjps.2019.11.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/13/2019] [Accepted: 11/23/2019] [Indexed: 01/05/2023]
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24
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Mittal L, Camarillo IG, Varadarajan GS, Srinivasan H, Aryal UK, Sundararajan R. High-throughput, Label-Free Quantitative Proteomic Studies of the Anticancer Effects of Electrical Pulses with Turmeric Silver Nanoparticles: an in vitro Model Study. Sci Rep 2020; 10:7258. [PMID: 32350346 PMCID: PMC7190727 DOI: 10.1038/s41598-020-64128-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/03/2020] [Indexed: 12/19/2022] Open
Abstract
Triple negative breast cancer (TNBC) represents 15–20% of the over one million new breast cancer cases occurring each year. TNBC is an aggressive cancer phenotype, with low 5-year survival rates, high 3-year recurrence rates, and increased risk of metastasis. A lack of three commonly exploited hormone receptors renders TNBC resistant to endocrine therapies and lends to its critical absence of viable therapeutic targets. This necessitates the development of alternate and effective novel therapeutic strategies for TNBC. Towards this, our current work seeks to develop the technique of Electrical pulse (EP)-mediated Turmeric silver nanoparticles (TurNP) therapy, known as Electrochemotherapy (ECT), to effectively target TNBC cells. This technique involves the efficient delivery of natural bioactive molecules with anti-cancer effects via a biophysical means. In these experiments, the bioactive molecules are turmeric, a dried rhizome of Curcuma longa that has been used for centuries, both as a dietary supplement and as a medicine in Ayurveda (science of life) in the Indian subcontinent and in traditional Chinese medicine. Our results reveal the combined effect of TurNP + EP treatment in reducing MDA-MB-231 cell viability to as low as 9% at 12 h. Showing biological selectivity, this combination treatment has a substantially lower effect on non-tumorigenic mammary epithelial MCF10A cells (67% viability). To gain mechanistic insights into the actions of TurNP-based ECT treatment, we performed high-throughput, label-free quantitative proteomics studies. Proteomics results indicate that TurNP + EP treatment significantly influenced expression of a diverse list of proteins, including receptors, transcription factors, structural proteins, kinases, and metabolic enzymes. This include the downregulation of 25 proteins in PI3K-Akt signaling pathway (such as GRB2, EGFR, EPHA2, GNB1, GNB2, 14–3–3 family, and Integrin family proteins), and 12 proteins (AKR1A1, ALDOA, ALDOC, PGK1, PGM1, PGAM1, ENO1, ENO2, GAPDH, TPI1, LDHA, and LDHB) in the glycolytic pathway with concomitant reduction in metabolite levels (glucose uptake, and intracellular- lactate, glutamine, and glutamate). Compared to TurNP alone, TurNP + EP treatment upregulated 66 endoplasmic reticulum and 193 mitochondrial proteins, enhancing several processes and pathways, including Pyruvate Metabolism, Tricarboxylic acid (TCA) cycle, and Oxidative Phosphorylation (OXPHOS), which redirected the TNBC metabolism to mitochondria. This switch in the metabolism caused excessive production of H2O2 reactive oxygen species (ROS) to inflict cell death in MDA-MB-231 cells, demonstrating the potency of this treatment.
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Affiliation(s)
- Lakshya Mittal
- School of Engineering Technology, Purdue University, West Lafayette, IN, 47907, USA
| | - Ignacio G Camarillo
- Department of Biological Sciences, Purdue University, West Lafayette, IN, 47907, USA.,Purdue Center for Cancer Research, Purdue University, West Lafayette, IN, 47907, USA
| | - Gowri Sree Varadarajan
- Division of High Voltage Engineering, Dept. of Electrical & Electronics Engineering, College of Engineering, Anna University, Guindy, Chennai, TN, 600025, India
| | - Hemalatha Srinivasan
- School of Life Sciences, B. S. Abdur Rahman Crescent Institute of Science & Technology, Chennai, TN, 600048, India
| | - Uma K Aryal
- Purdue Proteomics Facility, Bindley Bioscience Center, Purdue University, West Lafayette, IN, 47907, USA.,Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47907, USA
| | - Raji Sundararajan
- School of Engineering Technology, Purdue University, West Lafayette, IN, 47907, USA.
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25
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Long term response of electrochemotherapy with reduced dose of bleomycin in elderly patients with head and neck non-melanoma skin cancer. Radiol Oncol 2020; 54:79-85. [PMID: 32074076 PMCID: PMC7087420 DOI: 10.2478/raon-2020-0009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/04/2020] [Indexed: 11/21/2022] Open
Abstract
Background Electrochemotherapy (ECT) is a local cancer treatment based on electroporation where the electric field is used to enhance cell membrane permeability and thereby facilitating the transition of chemotherapeutic agents into the cell. For the treatment of non-melanoma skin cancer, a standard dosage of 15,000 IU/m2 bleomycin (BLM) is used. The aim of the present study was to evaluate the long-term ECT response in the group of elderly patients with non-melanoma skin cancer treated with a reduced dose of BLM in comparison to the outcome in the patients treated with the standard dose of BLM. Patients and methods Twenty-eight patients older than 65 years, with a total of 52 non-melanoma skin lesions were included in the study. Twelve patients (24 lesions) in the experimental group received a reduced dose of BLM (10,000 IU/m2), 16 patients (28 lesions) were treated with a standard dose of BLM (15,000 IU/m2). Results No statistically significant difference in tumor control was observed between both groups. In the experimental group, tumors recurred in 39.0% of treated lesions in a median follow-up time of 28 months. In the control group, the recurrence rate of treated lesions was 15.4% in a median follow-up time of 40 months. Conclusions ECT with a reduced dose of BLM is a feasible treatment option for elderly patients with equal efficacy to standard dose treatment and should be considered as a treatment modality in advanced aged patients with comorbidities, where overall life expectancy is poor.
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26
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Effective electrochemotherapy with curcumin in MDA-MB-231-human, triple negative breast cancer cells: A global proteomics study. Bioelectrochemistry 2020; 131:107350. [DOI: 10.1016/j.bioelechem.2019.107350] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/22/2022]
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27
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Kranjc Brezar S, Kranjc M, Čemažar M, Buček S, Serša G, Miklavčič D. Electrotransfer of siRNA to Silence Enhanced Green Fluorescent Protein in Tumor Mediated by a High Intensity Pulsed Electromagnetic Field. Vaccines (Basel) 2020; 8:E49. [PMID: 32012775 PMCID: PMC7157195 DOI: 10.3390/vaccines8010049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/10/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023] Open
Abstract
The contactless high intensity pulsed electromagnetic field (HI-PEMF)-induced increase of cell membrane permeability is similar to conventional electroporation, with the important difference of inducing an electric field non-invasively by exposing a treated tissue to a time-varying magnetic field. Due to the limited number of studies in the field of electroporation induced by HI-PEMF, we designed experiments to explore the feasibility of such a contactless delivery technique for the gene electrotransfer of nucleic acids in tissues in vivo. By using HI-PEMF for gene electrotransfer, we silenced enhanced green fluorescent protein (EGFP) with siRNA molecules against EGFP in B16F10-EGFP tumors. Six days after the transfer, the fluorescent tumor area decreased by up to 39% as determined by fluorescence imaging in vivo. In addition, the silencing of EGFP to the same extent was confirmed at the mRNA and protein level. The results obtained in the in vivo mouse model demonstrate the potential use of HI-PEMF-induced cell permeabilization for gene therapy and DNA vaccination. Further studies are thus warranted to improve the equipment, optimize the protocols for gene transfer and the HI-PEMF parameters, and demonstrate the effects of HI-PEMF on a broader range of different normal and tumor tissues.
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Affiliation(s)
- Simona Kranjc Brezar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia; (S.K.B.); (M.Č.); (G.S.)
| | - Matej Kranjc
- Faculty of Electrical Engineering, University of Ljubljana, Tržaška 25, 1000 Ljubljana, Slovenia;
| | - Maja Čemažar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia; (S.K.B.); (M.Č.); (G.S.)
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310 Izola, Slovenia
| | - Simon Buček
- Department of Cytopathology, Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia;
| | - Gregor Serša
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia; (S.K.B.); (M.Č.); (G.S.)
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
| | - Damijan Miklavčič
- Faculty of Electrical Engineering, University of Ljubljana, Tržaška 25, 1000 Ljubljana, Slovenia;
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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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29
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Clover AJP, Salwa SP, Bourke MG, McKiernan J, Forde PF, O'Sullivan ST, Kelly EJ, Soden DM. Electrochemotherapy for the treatment of primary basal cell carcinoma; A randomised control trial comparing electrochemotherapy and surgery with five year follow up. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 46:847-854. [PMID: 31862134 DOI: 10.1016/j.ejso.2019.11.509] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 11/25/2022]
Abstract
Basal cell carcinoma (BCC) are the commonest cutaneous malignancy and incidence continues to increase. There is a need to expand the therapeutic toolbox to increase options for patients that are unsuitable for or unwilling to undergo the current therapies. Electrochemotherapy (ECT) is a technique where cells are temporarily permeabilized after exposure to a brief pulsed electrical field and combined with low dose chemotherapeutics to ablate malignancies. It is a simple technique causing minimal damage to the surrounding healthy tissue and has the potential to avoid the need for complex reconstruction. ECT is an established treatment for skin metastases but its role as a primary treatment modality is not demonstrated. A prospective randomised control trial evaluating ECT against the gold standard of treatment, Surgery, was performed for patients with primary BCC and patients followed for 5 years. All lesions treated with ECT (n = 69) responded although 8/69 (12%) needed a second treatment to ensure a complete response. All surgical lesions (n = 48) showed histological evidence of complete excision with 2/48 (4%) undergoing a second excision. At 5 years, in the surgical arm there was no evidence of recurrence in 39/40 (97.5%) lesions with 1/40 (2.5%) confirmed recurrence. In the ECT arm there was no evidence of recurrence in 42/48 lesions (87.5%). There was 5 confirmed recurrences. These groups show statistical equivalence in this non inferiority study design (p = 0.33). ECT is an effective and durable treatment option for primary BCC and should be considered as part of the armamentarium of options available.
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Affiliation(s)
- A J P Clover
- Cancer Research @ UCC, Western Gateway Building, University College Cork, Ireland; Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland.
| | - S P Salwa
- Cancer Research @ UCC, Western Gateway Building, University College Cork, Ireland
| | - M G Bourke
- Cancer Research @ UCC, Western Gateway Building, University College Cork, Ireland
| | - J McKiernan
- Cancer Research @ UCC, Western Gateway Building, University College Cork, Ireland
| | - P F Forde
- Cancer Research @ UCC, Western Gateway Building, University College Cork, Ireland
| | - S T O'Sullivan
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - E J Kelly
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - D M Soden
- Cancer Research @ UCC, Western Gateway Building, University College Cork, Ireland
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A Novel 3D Scaffold for Cell Growth to Asses Electroporation Efficacy. Cells 2019; 8:cells8111470. [PMID: 31752448 PMCID: PMC6912677 DOI: 10.3390/cells8111470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/07/2019] [Accepted: 11/16/2019] [Indexed: 12/15/2022] Open
Abstract
Tumor electroporation (EP) refers to the permeabilization of the cell membrane by means of short electric pulses thus allowing the potentiation of chemotherapeutic drugs. Standard plate adhesion 2D cell cultures can simulate the in vivo environment only partially due to lack of cell–cell interaction and extracellular matrix (ECM). In this study, we assessed a novel 3D scaffold for cell cultures based on hyaluronic acid and ionic-complementary self-assembling peptides (SAPs), by studying the growth patterns of two different breast carcinoma cell lines (HCC1569 and MDA-MB231). This 3D scaffold modulates cell shape and induces extracellular matrix deposit around cells. In the MDA-MB 231 cell line, it allows three-dimensional growth of structures known as spheroids, while in HCC1569 it achieves a cell organization similar to that observed in vivo. Interestingly, we were able to visualize the electroporation effect on the cells seeded in the new scaffold by means of standard propidium iodide assay and fluorescence microscopy. Thanks to the presence of cell–cell and cell–ECM interactions, the new 3D scaffold may represent a more reliable support for EP studies than 2D cancer cell cultures and may be used to test new EP-delivered drugs and novel EP protocols.
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31
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Fukumoto T, Fukumoto R, Oka M, Horita N. Comparing treatments for basal cell carcinoma in terms of long‐term treatment‐failure: a network meta‐analysis. J Eur Acad Dermatol Venereol 2019; 33:2050-2057. [DOI: 10.1111/jdv.15796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/27/2019] [Indexed: 01/24/2023]
Affiliation(s)
- T. Fukumoto
- Gene Expression and Regulation Program The Wistar Institute Philadelphia PA USA
- Division of Dermatology Department of Internal Related Kobe University Graduate School of Medicine Kobe Japan
| | - R. Fukumoto
- Research Center for Advanced Science and Technology The University of Tokyo Tokyo Japan
| | - M. Oka
- Division of Dermatology Tohoku Medical and Pharmaceutical University Sendai Japan
| | - N. Horita
- Department of Pulmonology Yokohama City University Graduate School of Medicine Kanazawa Yokohama Japan
- National Human Genome Research Institute National Institutes of Health Bethesda MD USA
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Electrochemotherapy induces tumor regression and decreases the proliferative index in canine cutaneous squamous cell carcinoma. Sci Rep 2019; 9:15819. [PMID: 31676831 PMCID: PMC6825193 DOI: 10.1038/s41598-019-52461-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/13/2019] [Indexed: 12/29/2022] Open
Abstract
Canine cutaneous squamous cell carcinoma (cSCC) is the most common skin cancer in dogs, and, due to its low metastatic rate, local treatments, such as electrochemotherapy (ECT), promote disease control or even complete remission (CR). This study aimed to evaluate the gene and protein expression of Bcl-2 and Bcl-2 associated X protein (BAX), the proliferative index and clinical parameters in dogs with cSCC subjected to ECT. A prospective nonrandomized clinical study was performed using dogs with naturally occurring cSCC that was treated with ECT. Eighteen lesions from 11 dogs were selected. The tumor size at day 0 (D0) had no impact on survival or prognosis (P > 0.05). Tumor samples had a lower proliferative index after ECT (D21) than before ECT (P = 0.031). The survival of subjects with Ki67 values lower and higher than the Ki67 median value were not significantly different (P > 0.05). Regarding apoptotic markers, there were no significant differences in the gene and protein expression levels of BAX or Bcl-2 at D0 and D21 (P > 0.05) or in the overall survival of subjects with different levels of apoptotic markers. In conclusion, there was no change in BAX or Bcl-2 gene and protein expression in response to ECT at the time points evaluated, but ECT was able to reduce tumor volume and cellular proliferation in cSCC.
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Radiological findings of porcine liver after electrochemotherapy with bleomycin. Radiol Oncol 2019; 53:415-426. [PMID: 31600140 PMCID: PMC6884938 DOI: 10.2478/raon-2019-0049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022] Open
Abstract
Background Radiologic findings after electrochemotherapy of large hepatic blood vessels and healthy hepatic parenchyma have not yet been described. Materials and methods We performed a prospective animal model study with regulatory approval, including nine grower pigs. In each animal, four ultrasound-guided electroporated regions were created; in three regions, electrodes were inserted into the lumen of large hepatic vessels. Two types of electrodes were tested; variable linear- and fixed hexagonal-geometry electrodes. Ultrasonographic examinations were performed immediately and up to 20 minutes after the procedure. Dynamic computed tomography was performed before and at 60 to 90 minutes and one week after the procedure. Results Radiologic examinations of the treated areas showed intact vessel walls and patency; no hemorrhage or thrombi were noted. Ultrasonographic findings were dynamic and evolved from hyperechogenic microbubbles along electrode tracks to hypoechogenicity of treated parenchyma, diffusion of hyperechogenic microbubbles, and hypoechogenicity fading. Contrast-enhanced ultrasound showed decreased perfusion of the treated area. Dynamic computed tomography at 60 to 90 minutes after the procedure showed hypoenhancing areas. The total hypoenhancing area was smaller after treatment with fixed hexagonal electrodes than after treatment with variable linear geometry electrodes. Conclusions Radiologic findings of porcine liver after electrochemotherapy with bleomycin did not show clinically significant damage to the liver, even if a hazardous treatment strategy, such as large vessel intraluminal electrode insertion, was employed, and thus further support safety and clinical use of electrochemotherapy for treatment of hepatic neoplasia.
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Maintaining Quality of Life: Electrochemotherapy for Palliative Periorbital Malignancy. Ophthalmic Plast Reconstr Surg 2019; 35:e138-e142. [PMID: 31593036 DOI: 10.1097/iop.0000000000001468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Electrochemotherapy has been used successfully for treatment of recurrent head and neck skin cancers and skin metastasis. It combines both electroporation and chemotherapy. The authors report 4 patients, who all had metastatic periorbital malignancy. These patients were palliative with widespread metastatic malignancy. All patients had either already had multiple procedures or declined surgical resection and preferred less involved measures. The authors report technique and outcomes. Patient 1: 83-year-old man with recurrent malignant melanoma (MM) nodules (BRAF negative) in the left medial orbit and medial canthal area after rhinectomy and previous resections. Patient 2: 72-year-old man with metastatic MM who developed painful and unsightly metastatic nodules on the right and left forehead and the left medial canthus. Patient 3: 93-year-old man with background of widespread multiple myeloma, considered palliative. He developed a left forehead SCC, apparent as a fungating ulcer, which caused significant pain due to perineural invasion. Patient 4: 91-year-old woman with recurrent metastatic sebaceous cell carcinoma of the left lower eyelid obstructing her vision. All patients experienced an improvement in their pain and quality of life. None of the patients developed any significant periorbital inflammation or adverse complications. Electrochemotherapy may be a useful palliative treatment for periorbital tumors. It improves pain and reduces tumor volume. It can be considered for tumors where palliative radiotherapy may be contraindicated.Electrochemotherapy is a useful palliative treatment for metastases to the periorbital area, improving pain and size of the tumors.
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35
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Mittal L, Aryal UK, Camarillo IG, Ferreira RM, Sundararajan R. Quantitative proteomic analysis of enhanced cellular effects of electrochemotherapy with Cisplatin in triple-negative breast cancer cells. Sci Rep 2019; 9:13916. [PMID: 31558821 PMCID: PMC6763474 DOI: 10.1038/s41598-019-50048-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023] Open
Abstract
Due to the lack of the three main receptors, triple negative breast cancer (TNBC) is refractive to standard chemotherapy. Hence, alternate therapies are needed. TNBCs utilize glycolysis, which heightens their growth, proliferation, invasiveness, chemotherapeutic resistance and poor therapeutic response. This calls for novel therapeutic strategies to target these metabolic vulnerabilities present in TNBC. Electroporation-mediated chemotherapy, known as electrochemotherapy (ECT) is gaining momentum as an attractive alternative. However, its molecular mechanisms need better understanding. Towards this, label-free quantitative proteomics is utilized to gain insight into the anticancer mechanisms of ECT using electrical pulses (EP) and Cisplatin (CsP) on MDA-MB-231, human TNBC cells. The results indicate that EP + CsP significantly downregulated 14 key glycolysis proteins (including ENO1, LDHA, LDHB, ACSS2, ALDOA, and PGK1), compared to CsP alone. EP + CsP caused a switch in the metabolism with upregulation of 34 oxidative phosphorylation pathway proteins and 18 tricarboxylic acid (TCA) cycle proteins compared to CsP alone, accompanied by the upregulation of proteins linked to several metabolic reactions, which produce TCA cycle intermediates. Moreover, EP + CsP promoted multiple pathways to cause 1.3-fold increase in the reactive oxygen species concentration and induced apoptosis. The proteomics results correlate well with cell viability, western blot, and qPCR data. While some effects were similar for EP, more comprehensive and long-lasting effects were observed for EP + CsP, which demonstrate the potential of EP + CsP against TNBC cells.
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Affiliation(s)
- Lakshya Mittal
- School of Engineering Technology, Purdue University, West Lafayette, IN, 47907, USA
| | - Uma K Aryal
- Purdue Proteomics Facility, Bindley Bioscience Center, Purdue University, West Lafayette, IN, 47907, USA.
| | - Ignacio G Camarillo
- Department of Biological Sciences, Purdue University, West Lafayette, IN, 47907, USA
- Purdue Center for Cancer Research, Purdue University, West Lafayette, IN, 47907, USA
| | - Rodrigo M Ferreira
- Department of Biological Sciences, Purdue University, West Lafayette, IN, 47907, USA
| | - Raji Sundararajan
- School of Engineering Technology, Purdue University, West Lafayette, IN, 47907, USA.
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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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Electrochemotherapy as Promising Treatment Option in Rare Recurrent Cutaneous Neoplasm of the Scalp: Case Report of an Elderly Patient. Case Rep Oncol Med 2019; 2019:2507642. [PMID: 31049235 PMCID: PMC6458881 DOI: 10.1155/2019/2507642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/07/2019] [Accepted: 02/19/2019] [Indexed: 11/17/2022] Open
Abstract
Background Atypical fibroxanthoma (AFX) is a tumor that commonly presents on the head or neck in older individuals. Making a definitive diagnosis of AFX is challenging, and frequently, it is hard to distinguish from pleomorphic dermal sarcoma (PDS). There are no clear recommendations regarding the treatment of AFX, but an extensive surgery is actually considered the best option. Electrochemotherapy (ECT) is a novel therapeutic modality of local treatment in which the application of electrical pulses, enhancing cell membrane permeability, allows greater intracellular accumulation of chemotherapy drugs in the skin or subcutaneous tumors. Case Report We report a case of a 78-year-old male affected by a red, ulcerative, dermal, scalp nodule, which was treated with ECT with a complete clinical response. We have also reported literature data on this topic. Results In this case, ECT showed to be an effective and safe treatment for recurrent neoplasms of the head and neck, considering the complete response obtained and the absence of disease relapse after two years. Conclusion To the best of our knowledge, this is the first case report that shows great clinical results using ECT after surgery in relapsed AFX/PDS. However, more studies are needed to confirm our results.
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Esmaeili N, Friebe M. Electrochemotherapy: A Review of Current Status, Alternative IGP Approaches, and Future Perspectives. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:2784516. [PMID: 30719264 PMCID: PMC6335737 DOI: 10.1155/2019/2784516] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/20/2018] [Accepted: 12/17/2018] [Indexed: 12/15/2022]
Abstract
The efficiency of electroporation (EP) has made it a widely used therapeutic procedure to transfer cell killing substances effectively to the target site. A lot of researches are being done on EP-based cancer treatment techniques. Electrochemotherapy (ECT) is the first EP-based application in the field of drug administration. ECT is a local and nonthermal treatment of cancer that combines the use of a medical device with pharmaceutical agents to obtain local tumor control in solid cancers. It involves the application of eight, 100µs, pulses at 1 or 5000 Hz frequency and specified electric field (V/cm) with a median duration of 25 minutes. The efficacy of chemotherapeutic drugs increases by applying short and intense electrical pulses. Several clinical studies proposed ECT as a safe and complementary curative or palliative treatment option (curative intent of 50% to 63% in the treatment of Basal Cell Carcinoma (BCC)) to treat a number of solid tumors and skin malignancies, which are not suitable for conventional treatments. It is used currently for treatment of cutaneous and subcutaneous lesions, without consideration of their histology. On the contrary, it is also becoming a practical method for treatment of internal, deep-seated tumors and tissues. A review of this method, needed instruments, alternative image-guided procedures (IGP) approaches, and future perspectives and recommendations are discussed in this paper.
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Affiliation(s)
- Nazila Esmaeili
- INKA Intelligente Katheter, Otto-von-Guericke-Universität Magdeburg, Magdenurg, Germany
| | - Michael Friebe
- INKA Intelligente Katheter, Otto-von-Guericke-Universität Magdeburg, Magdenurg, Germany
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Frandsen SK, Gehl J. A Review on Differences in Effects on Normal and Malignant Cells and Tissues to Electroporation-Based Therapies: A Focus on Calcium Electroporation. Technol Cancer Res Treat 2018; 17:1533033818788077. [PMID: 30012047 PMCID: PMC6050800 DOI: 10.1177/1533033818788077] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Calcium electroporation is a potential novel anticancer treatment, where high
concentrations of calcium are introduced into the cell cytosol by electroporation. This is
a method where short, high-voltage pulses induce a transient permeabilization of the cell
membrane and thereby allow influx and efflux of ions and molecules. Electroporation is
used in combination with chemotherapeutic drugs (electrochemotherapy) as a standard
treatment for cutaneous metastases, and electroporation using a higher electric field and
number of pulses (irreversible electroporation) is increasingly being used as an
anticancer treatment. In this review, calcium electroporation is described with emphasis
on the investigations of differences in the effect on normal and malignant cells and
tissues in vitro and in vivo. Calcium electroporation
has been shown to induce cell death in vitro and tumor necrosis
in vivo with a difference in sensitivity between different tumor types.
Normal cells treated in vitro are significantly less affected than cancer
cells, and a similar trend is shown in vivo where muscle and skin tissue
surrounding a treated tumor as well as muscle and skin directly treated with calcium
electroporation were less affected than tumors. The mechanism behind this difference in
sensitivity is not fully understood but might be affected by differences in electric
impedance, membrane repair, and expression of plasma membrane calcium ATPases in normal
and malignant cells. The research on calcium electroporation shows a potential novel
anticancer treatment with significant effect on cancer cells and tissues while normal
cells and tissues are clearly less affected.
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Affiliation(s)
- Stine K Frandsen
- 1 Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Julie Gehl
- 1 Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark.,2 Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Groselj A, Kranjc S, Bosnjak M, Krzan M, Kosjek T, Prevc A, Cemazar M, Sersa G. Vascularization of the tumours affects the pharmacokinetics of bleomycin and the effectiveness of electrochemotherapy. Basic Clin Pharmacol Toxicol 2018; 123:247-256. [DOI: 10.1111/bcpt.13012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/12/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery; University Medical Centre Ljubljana; Ljubljana Slovenia
- Faculty of Medicine; University of Ljubljana; Ljubljana Slovenia
| | - Simona Kranjc
- Department of Experimental Oncology; Institute of Oncology Ljubljana; Ljubljana Slovenia
| | - Masa Bosnjak
- Department of Experimental Oncology; Institute of Oncology Ljubljana; Ljubljana Slovenia
| | - Mojca Krzan
- Faculty of Medicine; Department of Pharmacology and Experimental Toxicology; University of Ljubljana; Ljubljana Slovenia
| | - Tina Kosjek
- Department of Environmental Sciences; Jozef Stefan Institute; Ljubljana Slovenia
| | - Ajda Prevc
- Department of Experimental Oncology; Institute of Oncology Ljubljana; Ljubljana Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology; Institute of Oncology Ljubljana; Ljubljana Slovenia
- Faculty of Health Sciences; University of Primorska; Izola Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology; Institute of Oncology Ljubljana; Ljubljana Slovenia
- Faculty of Health Sciences; University of Ljubljana; Ljubljana Slovenia
- Faculty of Health Sciences; University of Primorska; Izola Slovenia
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Rotunno R, Campana LG, Quaglino P, de Terlizzi F, Kunte C, Odili J, Gehl J, Ribero S, Liew SH, Marconato R, Brizio M, Curatolo P. Electrochemotherapy of unresectable cutaneous tumours with reduced dosages of intravenous bleomycin: analysis of 57 patients from the International Network for Sharing Practices of Electrochemotherapy registry. J Eur Acad Dermatol Venereol 2017; 32:1147-1154. [PMID: 29178483 DOI: 10.1111/jdv.14708] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 11/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Electrochemotherapy (ECT) is currently used to treat unresectable superficial tumours of different histotypes through the combination of cytotoxic chemotherapy and local application of electric pulses. In 2006, a collaborative project defined the ESOPE (European Standard Operating Procedures of Electrochemotherapy) guidelines to standardize the procedure. The International Network for Sharing Practices of Electrochemotherapy (InspECT) aims to refine the ESOPE and improve clinical practice. Limiting patient exposure to systemic chemotherapy would be advisable to ameliorate ECT safety profile. OBJECTIVE The aim of this study was to evaluate the efficacy and toxicity of ECT with reduced chemotherapy dosages. METHODS In a retrospective analysis of a prospectively maintained database (InspECT registry), we evaluated the outcome of patients who received ECT with reduced dosages of bleomycin (7500, 10 000 or 13 500 IU/m2 , instead of the standard dose of 15 000 IU/m2 ). Tumour response in melanoma patients was compared with melanoma patients of the InspECT registry who received the standard dose of bleomycin. RESULTS We identified 57 patients with 147 tumours (melanoma, 38.6%; squamous cell carcinoma, 22.8%; basal cell carcinoma, 17.5%; breast cancer 7%; Kaposi sarcoma 7%; other histotypes, 7.1%). Per-tumour complete response (CR) rate at 60 days was 70.1% (partial, 16.3%); per-patient CR was 57.9% (partial, 21.1%). Local pain was the most frequently reported side-effect (n = 22 patients [39%]), mostly mild; two patients experienced flu-like symptoms, one patient nausea. We observed the same CR rate (55%) in patients with melanoma treated by reduced or conventional bleomycin dosages (P = 1.00). CONCLUSIONS Electrochemotherapy performed with reduced bleomycin dosages could be as effective as with currently recommended dose. Patients with impaired renal function or candidate to multiple ECT cycles could benefit from a reduced dose protocol. Our findings need prospective confirmation before being adopted in clinical practice.
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Affiliation(s)
- R Rotunno
- Dermatologic Clinic, 'Sapienza' University of Rome, Rome, Italy
| | - L G Campana
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy.,Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - P Quaglino
- Dermatologic Clinic, Department Medical Sciences, University of Turin, Turin, Italy
| | - F de Terlizzi
- Scientific & Medical Department, IGEA S.p.A., Carpi, Modena, Italy
| | - C Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik München, Munich, Germany.,Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Munich, Germany
| | - J Odili
- Plastic and Reconstructive Surgeon, St Georges' University Hospitals NHS Foundation Trust, London, UK
| | - J Gehl
- Center for Experimental Drug and Gene Electrotransfer, Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - S Ribero
- Dermatologic Clinic, Department Medical Sciences, University of Turin, Turin, Italy
| | - S H Liew
- Department of Plastic Surgery, Whiston Hospital, Liverpool, UK
| | - R Marconato
- Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - M Brizio
- Scientific & Medical Department, IGEA S.p.A., Carpi, Modena, Italy
| | - P Curatolo
- Dermatologic Clinic, 'Sapienza' University of Rome, Rome, Italy
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