Alternatives for the treatment of local advanced disease: electrochemotherapy, limb perfusion, limb infusion, intralesional IL2. What is the role?

Testori, Alessandro; Intelisano, Antonio; Verrecchia, F.; Menicanti, Claudia; Tosti, Giulio; Grassi, Elisa; Pari, C.; Pennacchioli, Elisabetta

doi:10.1111/j.1529-8019.2012.01486.x

Cited by 10 publications

(5 citation statements)

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“…Early clinical studies were conducted in patients with in-transit metastatic melanoma [31][32][33][34][35]. Following the publication of the ESOPE study results, several additional studies have been conducted since and lead to identification of ECT role in patients with stage III and IV melanoma [66,[74][75][76][77][78][79][80][81]. The involvement of patients' immune cells after ECT has suggested to investigated the effect of combining ECT treatment with systemic immunomodulating agents in melanoma patients [27,82].…”

Section: Clinical Experiencesmentioning

confidence: 99%

Locally Enhanced Chemotherapy by Electroporation: Clinical Experiences and Perspective of Use of Electrochemotherapy

2014

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Electroporation is used to enhance drug diffusion and gene delivery into the cytosol. The combination of electroporation and cytotoxic drugs, electrochemotherapy (ECT), is used to treat metastatic tumor nodules located at the skin and subcutaneous tissue. The objective response rate following a single session of treatment exceeds 80%, with minimal toxicity for the patients. The efficacy of ECT in the bone and visceral metastasis is currently investigated, and Phase II studies have been completed. ECT has been used to treat skin primary tumors, except melanoma, and is under investigation for locally advanced pancreatic cancer. Early evidence suggests that treatment of tumor nodules with ECT recruits components of the immune system and eliciting a systemic immune response against cancer is a challenging clinical perspective. Considering the proven safety in several different clinical applications electroporation should be viewed as a clinical platform technology with wide perspectives for use in ECT, gene therapy and DNA vaccination.

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Section: Clinical Experiencesmentioning

confidence: 99%

Locally Enhanced Chemotherapy by Electroporation: Clinical Experiences and Perspective of Use of Electrochemotherapy

2014

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“…The electric pulse creates cell membrane poration resulting in a better penetration of the chemotherapeutic agent. [52,53] A study has reported a 72% objective response rate of the total of 54 lesions treated with electrochemotherapy. [53] However, superiority of one over the other has not been proven and the choice of the method depends on individual factors.…”

Section: Surgery Of Locoregional Recurrence Of Melanomamentioning

confidence: 99%

Surgery and Staging of Melanoma

Gyulai¹,

Kádár²,

Lengyel³

2015

Melanoma - Current Clinical Management and Future Therapeutics

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Early diagnosis and complete removal of the malignant cells are of paramount importance in the treatment of malignant melanoma. This usually requires a two-step approach. First, pigmented or amelanotic lesions suspicious for melanoma should be promptly biopsied and submitted to pathological evaluation, and second, the tumor should be subsequently excised with adequate surgical margins. The margins of the final excision are determined with the tumor characteristics in mind, as determined by the histopathological analysis of the biopsy specimen. Thus, removal of appropriate biopsy sample containing the fragment with the worst prognostic characteristics, is of substantial importance. As extensive loss of tissues may potentially influence the feasibility of further surgical interventions, such as the sentinel lymph node biopsy, the use of proper biopsy techniques is essential during the primary treatment of melanoma. Recommendations regarding the width of the surgical margin of excision are nowadays clearly defined for primary melanoma, and are based on the histopathological features of the melanoma. These recommendations, however, are sometimes difficult or impossible to follow, like in the case of specially localized melanomas, or certain melanoma subtypes. This chapter summarizes the available evidence regarding different biopsy techniques and the surgical management of primary melanoma. 2.1. Biopsy of melanoma suspect lesions The primary aim of performing biopsy in the case of a melanoma suspect lesion is to establish or exclude the diagnosis of melanoma. An additional goal is to ensure accurate pathological staging of the tumor in order to enable adequate surgical management by performing wide local excision (WLE). Excisional, incisional and shave biopsy techniques are used in the surgical treatment of melanoma. 2.1.1. Excisional biopsy The preferred biopsy technique for most melanomas is excisional biopsy.[1,2] This means that the entire lesion is removed with an additional 1-3 mm margin of normal-appearing skin. Wider excisions, however, should be avoided, to permit subsequent lymphatic mapping for sentinel lymph node biopsy. Generally, the excised tissue sample should contain part of the subcutaneous fat as well, and should be oriented to aid subsequent histopathological evaluation. The positioning of the excision also should possibly allow for subsequent wider excisions. The excisional biopsy technique can be used in most melanomas, when primary closure of the wound is feasible. Although the lowest frequency of positive margins is reported when excisional biopsy is used, positive margins and even residual melanoma on WLE do occur.[3] 2.1.2. Incisional biopsy The reported frequency of excisional biopsy technique used for diagnosing melanoma varies significantly with centers, countries, and individuals, and ranges between 10 and 86 percent.

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“…Repeat ILI has demonstrated similar ORR as initial ILI and is offered to patients with unresectable disease recurrence who previously demonstrated a response with an initial ILI or ILP (21). Other therapies such as electrochemotherapy (ECT) and intralesional immunotherapy have also shown promise, although long-term efficacy remains to be determined (22, 23). …”

Section: Discussionmentioning

confidence: 99%

Resection of Residual Disease after Isolated Limb Infusion (ILI) Is Equivalent to a Complete Response after ILI-Alone in Advanced Extremity Melanoma

et al. 2013

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Introduction Isolated limb infusion (ILI) is a limb-preserving treatment for in-transit extremity melanoma. The benefit of resecting residual disease following ILI is unclear. Methods A multi-institutional experience was analyzed comparing patients who underwent ILI plus resection of residual disease (ILI+RES) versus ILI-alone. Results 176 patients were included: 154 ILI-alone and 22 ILI+RES. There were no differences between the groups with respect to gender, age, extremity affected, or time from diagnosis to ILI. All surgical resections were performed as an outpatient procedure, separate from the ILI. Within the ILI+RES group, fifteen (68%) had a partial response (PR), two (9%) stable disease (SD), and 5 (23%) progressive disease (PD). The ILI-alone group had 52 (34%) CR, 30 (19%) PR, 15 (10%) SD, and 46 (30%) PD. Eleven (7%) ILI-alone patients did not have 3-month response available for review. Evaluating overall survival (OS) from date of ILI, the ILI-alone group had a median OS of 30.9 months, whereas the ILI+RES group had not reached median OS, p=0.304. Although the ILI+RES group had a slightly longer disease free survival (DFS) compared to those with a CR after ILI-alone (12.4 vs. 9.6), this was not statistically significant, p=0.978. Within the ILI+RES group, those with an initial PR following ILI had improved DFS vs. those with SD or PD following ILI, p<0.0001. Conclusion Resection of residual disease following ILI offers a DFS and OS similar to those who have a CR after ILI-alone, and may offer a treatment strategy that benefits more patients undergoing ILI.

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Alternatives for the treatment of local advanced disease: electrochemotherapy, limb perfusion, limb infusion, intralesional IL2. What is the role?

Cited by 10 publications

References 50 publications

Locally Enhanced Chemotherapy by Electroporation: Clinical Experiences and Perspective of Use of Electrochemotherapy

Locally Enhanced Chemotherapy by Electroporation: Clinical Experiences and Perspective of Use of Electrochemotherapy

Surgery and Staging of Melanoma

Resection of Residual Disease after Isolated Limb Infusion (ILI) Is Equivalent to a Complete Response after ILI-Alone in Advanced Extremity Melanoma

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