European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project: Results of the treatment of skin cancer

Abstract

Electrochemotherapy is an effective and safe method for local treatment of cutaneous and subcutaneous tumours, where electric pulses cause increased permeability of cell membranes in the tumour mass, enabling dramatically enhanced effectiveness of bleomycin and other hydrophilic drugs. Here, we report results of a European multi-institutional prospective study of the effectiveness of electrochemotherapy in the treatment of skin cancer of the head and neck (HN) area, where standard treatments had either failed or were not deemed suitable or declined by the patient. A total of 105 patients affected by primary or recurrent skin cancer of the HN area were enrolled; of these, 99 were eligible for evaluation of tumour response. By far, the majority (82%) were treated only once, and 18% of patients had a second treatment. The objective response was highest for basal cell carcinoma (97%) and for other histologies was 74%. Small, primary, and treatment-naive carcinomas responded significantly better (p < 0.05), as investigated by univariate analysis. Electrochemotherapy was well tolerated and led to a significant improvement of quality of life, estimated by the European Organisation for Research and Treatment of Cancer quality of life questionnaires. At 1-year follow-up, the percentages of overall and disease-free survival were 76% and 89%, respectively. Electrochemotherapy is an effective option for skin cancers of the HN area and can be considered a feasible alternative to standard treatments when such an alternative is appropriate. The precise role for electrochemotherapy in the treatment algorithm for non-melanoma skin cancer of the HN region requires data from future randomised controlled studies. (ISRCTN registry N. 30427).

Basal cell carcinoma: 10-year experience with electrochemotherapy

“…It is remarkable that no comparative trials have been carried out so far and no cost-analyses are available. The bulk of the literature consists of small observational series, often including heterogeneous skin cancers [10, 12, 14–18, 24]. In an early trial, Glass et al [16] reported a 98% response rate after one or more ECT cycles with intralesional bleomycin and no recurrences detected after 18 months.…”

“…A recent meta-analysis assessing 47 prospective studies on patients with cutaneous metastases—mainly from melanoma and breast cancer—treated by skin-directed therapies (including ECT, radiation, photodynamic, intralesional and topical therapies) showed sustained response rates across treatments with G ≥ 3 dermatological toxicity in less than 6% of patients [26]. More recently, a European and an Italian multicenter studies (both adopting the ESOPE protocol), have reported CR rates of 91 and 66.7%, respectively, in BCC patients, although with a short follow-up (6 and 13.9 months, respectively) [10, 11]. In 2016, Rotunno et al reported a 75% CR rate in patients with head and neck BCC treated by ECT.…”

“…However, since the evidence basis is limited and established treatments provides high cure rates, clinicians involved in ECT are encouraged to systematically collect data on case selection, treatment parameters, patient outcomes and, possibly, to submit these data to the International Network for Sharing practices on Electrochemotherapy (InspECT) register (website: http://www.insp-ect.org/) [13]. Although BCC is by far the most frequent skin cancer, clinical experience with ECT is still scarce [10–12, 14–18], probably due to the availability of several established treatment options [19]. In the present study, we sought to examine the feasibility, efficacy and toxicity of ECT in BCC and to gain insights into this potential field of ECT application.…”

Electrochemotherapy efficacy evaluation for treatment of locally advanced stage III cutaneous squamous cell carcinoma: a 22-cases retrospective analysis

“…At 2 months from ECT SCC group showed the higher percentage of OR (79%) with 55% of CR and 24% of PR. Interestingly, for recurrent tumour nodules, previous surgery least affected the outcome compared to (chemo) radiotherapy or multiple treatments [36]. …”

Electrochemotherapy induces apoptotic death in melanoma metastases: a histologic and immunohistochemical investigation

“…Several clinical studies have demonstrated the safety and efficacy of ECT in the tumor control of a wide range of primary and metastatic malignancies 6–8,13. In particular, ECT has been shown to be a safe and effective treatment option in a palliative setting for melanoma cutaneous and subcutaneous metastases 14–16.…”