Melanoma Information

The role of Electrochemotherapy in the treatment of patients with metastatic melanoma.

Rationale

Patients who have advanced metastatic melanoma often present with multiple cutaneous metastases (CM), which are notoriously difficult to treat. These commonly present on the torso and the lower and upper limbs. However, systemic therapy alone can have limited efficacy in the treatment of CM. CM can cause significant morbidity including infection, bleeding, odour and pain. Many patients associate CM with the greatest effect on quality of life. [1]

Studies with Electrochemotherapy in metastatic melanoma patients

Several clinical studies demonstrate the efficacy and safety of Electrochemotherapy treatment with the CLINIPORATORTM in metastatic melanoma patients. [2]

 

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Combination treatment in metastatic melanoma

Following Electrochemotherapy treatment, it has been observed that the release of tumour antigens can facilitate the immune response. Early clinical experiences indicate that this combination therapy can positively impact on patients’ long term survival.

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Efficacy of Electrochemotherapy

Electrochemotherapy can be a single treatment option but also may be used multiple times if required. The treatment consists of a single intravenous injection of bleomycin followed by a local application of electrical pulses.

Analysis of the results from the European Register InspECT, for the treatment of multiple skin locations, states: “Notably, the local tumour control was 86% at 200 days of follow-up, meaning that patients with complete response maintained their response for a prolonged period of time”. [3]

Patients who show the best response to Electrochemotherapy

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NICE Guidance
 

In 2013 NICE has published a recommendation about Electrochemotherapy where symptoms can be reduced and quality of life can be improved on selected patients:
“There is sufficient evidence of efficacy of electrochemotherapy for treating metastases in the skin from tumours of nonskin origin and melanoma to support its use as a palliative treatment. There are no major safety concerns. Therefore, in the context of palliative treatment the procedure can be used with normal arrangements for clinical governance, consent and audit”.

Electrochemotherapy in practice

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The figures show a 58 years patient with multiple cutaneous metastases on the leg. Two months after the treatment with Electrochemotherapy, no HMB-45 cells were present in the treated area at the histologic analysis.

Conclusions

Treatment with Electrochemotherapy is particularly effective in patients with metastatic melanoma. Electrochemotherapy can be used in combination with immunotherapy and local therapies.

Treatment of metastatic melanoma has a significant positive effect on the patient’s quality of life. Electrochemotherapy is a fundamental and essential treatment within the therapeutic programme for patients with metastatic melanoma.

 

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Information & Support

References

1. Spratt DE et al. Efficacy of Skin-Directed Therapy for Cutaneous Metastases From Advanced Cancer: A Meta-Analysis. J Clin Oncol. 2014 Oct 1;32(28):3144-55.
2. Testori A et al. Diagnosis and treatment of in-transit melanoma metastases. Eur J Surg Oncol. 2017 Mar;43(3):544-560.
3. Kunte C et al. Electrochemotherapy in the treatment of metastatic malignant melanoma: A prospective cohort study by InspECT. Br J Dermatol. 2017 Jan 24.
4. Campana LG et al. Treatment efficacy with electrochemotherapy: A multi-institutional prospective observational study on 376 patients with superficial tumors. Eur J Surg Oncol. 2016 Dec;42(12):1914-1923.
5. Ricotti F et al. Electrochemotherapy: an effective local treatment of cutaneous and subcutaneous melanoma metastases. Dermatol Ther. 2014 May-Jun;27(3):148-52.
6. Caracò C et al. Electrochemotherapy in melanoma patients: a single institution experience. Melanoma Manag. (2015) 2(2), 127-132.
7. Campana LG et al. Electrochemotherapy for disseminated superficial metastases from malignant melanoma. Br J Surg. 2012 Jun;99(6):821-30.
8. Heppt MV et al. Immune checkpoint blockade with concurrent electrochemotherapy in advanced melanoma: a retrospective multicenter analysis. Cancer Immunol Immunother. 2016 Aug;65(8):951-9.
9. Theurich S et al. Local Tumor Treatment in Combination with Systemic Ipilimumab Immunotherapy Prolongs Overall Survival in Patients with Advanced Malignant Melanoma. Cancer Immunol Res. 2016 Sep 2;4(9):744-54.
10. Mozzillo N et al. Assessing a novel immuno-oncology-based combination therapy: Ipilimumab plus electrochemotherapy. Oncoimmunology. 2015 May 22;4(6):e1008842.
11. Brizio M et al. Complete regression of melanoma skin metastases after electrochemotherapy plus ipilimumab treatment: an unusual clinical presentation. Eur J Dermatol. 2015 May-Jun;25(3):271-2.
12. Valpione S et al. Consolidation electrochemotherapy with bleomycin in metastatic melanoma during treatment with dabrafenib. Radiol Oncol. 2015 Mar; 49(1): 71–74.

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