Metastatic Basal Cell Carcinoma With Squamous Differentiation

Fantini, Fabrizio; Gualdi, Giulio; Cimitan, A; Giannetti, Alberto

doi:10.1001/archderm.144.9.1186

Cited by 31 publications

(5 citation statements)

References 12 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…According to the European standard operative procedure of ECT (ESOPE), bleomycin can be administered either intratumorally or intravenously, according to the disease burden, while cisplatin can be injected intratumorally, in patients with few and small tumors [7]. Since the publication of the ESOPE in 2006, an increasing number of studies have provided evidence of ECT efficacy on different tumor histotypes [8–12]. On this basis, the National Institute for Health and Care Excellence (NICE) has recently recognized ECT as a safe alternative option for BCC patients (NICE interventional procedure guidance [IPG478], published date: February 2014).…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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Basal cell carcinoma: 10-year experience with electrochemotherapy

et al. 2017

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BackgroundElectrochemotherapy (ECT), by combining manageable cytotoxic agents with short electric pulses, represents an effective palliative skin-directed therapy. The accumulated evidence indicates that ECT stands out as a safe and well-tolerated alternative treatment for patients with multiple or large basal cell carcinoma (BCC), who are not suitable for conventional treatments. However, long-term data and shared indications are lacking.MethodsIn this observational study, we retrospectively analyzed 84 prospectively collected patients with multiple, recurrent or locally advanced BCC who were not candidate for standard therapies and received bleomycin-based ECT according to the European Standard Operative Procedures of ECT, from 2006 to 2016.ResultsDisease extent was local, locally advanced and metastatic in 40 (48%), 41 (49%) and 3 (3%), respectively. Forty-four (52%) individuals had multiple BCCs. Grade 3 skin toxicity after ECT was observed in 6% of cases. Clearance rate was 50% (95% CI 39–61%). Primary presentation (p = 0.004), tumor size <3 cm (p < 0.001), well-defined borders (p = 0.021), absence of tumor ulceration (p = 0.001), non-aggressive BCC histology (p = 0.046) and age ≤69 years were associated with higher complete response rate. In patients with local BCC, the clearance rate was 72.5 and 85% after one or two ECT cycles, respectively. In the laBCC group, 32 patients (78%) achieved an objective response. Five-year recurrence rate for local and laBCC was 20 and 38%, respectively (p ≤ 0.001).ConclusionsOne or two ECT cycles with bleomycin may be a valuable palliative treatment in well-selected patients with multiple BCCs and favorable tumor features. Validation of predictive factors will be imperative to match patients with optimal ECT treatment modalities. Management of laBCC with ECT warrants further investigation. Trial registration ISRCTN14633165 Registered 24 March 2017 (retrospectively registered)Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-017-1225-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Basal cell carcinoma: 10-year experience with electrochemotherapy

et al. 2017

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“…The multicenter study ESOPE (European Standard Operating Procedure for ECT) demonstrated that ECT may achieve an objective response rate of 85 % (74 % complete response rate) in treated tumour lesions [5,6]. Furthermore, in nodules undergoing complete response, long-term histology shows that no residual tumour cells are detected locally [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Electrochemotherapy in the Treatment of Bone Metastases: A Phase II Trial

et al. 2016

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IntroductionBone metastatic disease is a major cause of pain and decreased quality of life in patients with cancer. In addition to systemic therapy and pain control with narcotic analgesics, standard local treatments include palliation with radiation therapy and surgery. However, 20–30 % of patients do not respond to conventional treatments, increasing the interest in alternative therapies. We present the results of a new minimally invasive technique in the treatment of bone metastases.MethodsTwenty-nine patients affected by painful bone metastases were treated with electrochemotherapy (ECT) from July 2009 to July 2011; the mean age was 60 years (range 37–87); 21 patients received a previous ineffective local treatment; the appendicular skeleton was affected in 15 patients while in 14 patients other sites were involved. ECT was performed using the Cliniporator Vitae under fluoroscopy or CT guidance depending on the site of the lesion. Clinical response was assessed using VAS scale and objective tumour response was evaluated according to the MD Anderson criteria for bone metastases.ResultsAll patients well tolerated the procedure and no intraoperative or postoperative complications were observed. At a mean follow-up of 7 months, 24 patients were available for evaluation. 84 % of the patients (20 out of 24) referred improvement of pain ≥50 % with reduction of narcotics consumption. Radiographic evaluation after 3 months in 20 evaluable patients, showed “partial response” in 1 patient, “stable disease” in 17 and “progression” in two cases.DiscussionResults reported in this study demonstrated ECT to be safe and feasible in the treatment of painful bone metastases even when other previous treatments were ineffective. Pain and disease progression control was achieved in the majority of the patients with consequent improvement of quality of life.ConclusionECT should be considered a new feasible tool in the treatment of bone metastases in place or in combination with standard treatments; further developments are required to extend the use of this technique to spine metastases.

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“…Similarly, the indirect effects after bleomycin electrotransfer as well as irreversible electroporation can also be associated with the bystander effect. It is important to note that bleomycin electrotransfer is closely associated with antitumor electrochemotherapy (ECT), an anticancer treatment modality that is currently implemented in clinics over the world as a local anticancer treatment therapy [ 38 , 39 ]. A well-known process of bleomycin-induced ROS generation in the presence of metal ions, like Cu + or Fe 2+ , and oxygen, results in cellular DNA degradation [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

The Evidence of the Bystander Effect after Bleomycin Electrotransfer and Irreversible Electroporation

et al. 2021

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One of current applications of electroporation is electrochemotherapy and electroablation for local cancer treatment. Both of these electroporation modalities share some similarities with radiation therapy, one of which could be the bystander effect. In this study, we aimed to investigate the role of the bystander effect following these electroporation-based treatments. During direct CHO-K1 cell treatment, cells were electroporated using one 100 µs duration square wave electric pulse at 1400 V/cm (for bleomycin electrotransfer) or 2800 V/cm (for irreversible electroporation). To evaluate the bystander effect, the medium was taken from directly treated cells after 24 h incubation and applied on unaffected cells. Six days after the treatment, cell viability and colony sizes were evaluated using the cell colony formation assay. The results showed that the bystander effect after bleomycin electrotransfer had a strong negative impact on cell viability and cell colony size, which decreased to 2.8% and 23.1%, respectively. On the contrary, irreversible electroporation induced a strong positive bystander effect on cell viability, which increased to 149.3%. In conclusion, the results presented may serve as a platform for further analysis of the bystander effect after electroporation-based therapies and may ultimately lead to refined application of these therapies in clinics.

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Metastatic Basal Cell Carcinoma With Squamous Differentiation

Cited by 31 publications

References 12 publications

Basal cell carcinoma: 10-year experience with electrochemotherapy

Basal cell carcinoma: 10-year experience with electrochemotherapy

Electrochemotherapy in the Treatment of Bone Metastases: A Phase II Trial

The Evidence of the Bystander Effect after Bleomycin Electrotransfer and Irreversible Electroporation

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