Electrochemotherapy for the treatment of cutaneous squamous cell carcinoma: The INSPECT experience (2008-2020)

Abstract

IntroductionCutaneous squamous cell carcinoma (cSCC) is a frequent skin cancer with a high risk of recurrence characterized by tumor infiltration and, in advanced cases, a poor prognosis. ECT (electrochemotherapy) is an alternative treatment option for locally advanced or recurrent cSCC that is unsuitable for surgical resection. In this study, we aimed to evaluate the data in the InspECT (International Network for Sharing Practice on ECT) registry of the referral centers and to clarify the indications for the use of ECT as a treatment modality for cSCC.Materials and methodsPatients with primary, recurrent or locally advanced cSCC from 18 European centers were included. They underwent at least one ECT session with bleomycin between February 2008 and November 2020, which was performed following the European Standard Operating Procedures.ResultsThe analysis included 162 patients (mean age of 80 years; median, 1 lesion/patient). Side effects were mainly local and mild (hyperpigmentation, 11%; ulceration, 11%; suppuration, 4%). The response to treatment per patient was 62% complete and 21% partial. In the multivariate model, intravenous drug administration and small tumor size showed a significant association with a positive outcome (objective response). One-year local progression-free survival was significantly better (p<0.001) in patients with primary tumors (80% (95% C.I. 70%-90%) than in patients with locally advanced disease (49% (95% C.I. 30%-68%).ConclusionIn the present study, ECT showed antitumor activity and a favorable safety profile in patients with complex cSCC for whom there was no widely accepted standard of care. Better results were obtained in primary and small tumors (<3 cm) using intravenous bleomycin administration.

Electrochemotherapy as palliative care in patients with local or metastatic recurrence of head and neck cancer: review of state of the art

“…Regarding quality of life, many studies have reported significant improvement in wellness perception as measured by the EuroQoL 5-dimensions questionnaire, and an important increase in physical and role functioning, with a decrease in pain and fatigue as quantified by the European Organization for Research and Treatment of Cancer core 30 quality-of-life questionnaire. Moreover, the analysis by the EORTC 35-question head and neck cancer-specific module demonstrated an improvement in all domains, in particular regarding the perception of feeling ill, pain, need for pain medication, and mouth opening 11 .…”

“…When it comes to tumour size, it has been demonstrated to be inversely proportional to the efficacy of ECT. In particular, Bertino et al 11 demonstrated that smaller lesions (< 3 cm) had better response, ECT was more successful in primary tumours than recurrences or metastases, and pre-treated lesions had worse responses than naïve ones. Specifically, lesions with a diameter ≤ 3 cm had an overall response rate of 88% vs 68% in those with a diameter > 3 cm.…”

“…A patient with a large, ulcerated lesion died because of a septic shock 2 days after ECT, despite antibiotic treatment and best supportive care. In case of full thickness lesions of the cheek, tumour necrosis with loss of oral competence and salivary fistula have been observed 11 . Other minor side effects reported in the literature are swelling, hyperpigmentation, maculo-papular rash, ulceration, and odour.…”

“…Overall, ECT in the oral cavity, oropharynx and hypopharynx is considered to be safe, with rare cases of bleeding. Swelling of the mucosa in this region can be dangerous if not expected and handled appropriately, for example with preventive tracheostomy 11 .…”

Electrochemotherapy combined with immunotherapy – a promising potential in the treatment of cancer

“…The complete and partial response rates were 62% and 21% respectively. Better results were achieved in patients with primary and smaller (< 3 cm) tumors using intravenously administered bleomycin ( 60 ).…”