Other Cancers Information

  • B-cell Lymphomas Information

    The role of Electrochemotherapy in the treatment of cutaneous marginal zone B-cell Lymphomas

    Introduction

    Electrochemotherapy is a treatment combining a low dose of a chemotherapy drug and an electrical pulse (electroporation) applied directly to the cancer cells using an electrode.

    This low level dose of chemotherapy drug is not normally effective against the cancer, as it is difficult to get inside the cells. When the electrical pulse is applied, the cells form pores allowing the drug to enter and be active against the cancer.

    Electrochemotherapy for B-cell Lymphoma patients

    In a recent study, Gatti et al [1] described the use of Electrochemotherapy as an alternative therapy for primary cutaneous marginal zone B-cell Lymphomas in patients unsuitable for surgery or radiotherapy.

    Their experience referred to three patients with primary cutaneous marginal zone B-cell Lymphomas treated with specifi c antimicrobial therapy and Electrochemotherapy. These patients presented with multifocal circumscribed lesions; therefore, an alternative approach to surgery was chosen.

    Clinical Experience

    Electrochemotherapy is known to be an efficient loco-regional therapy for treatment of unresectable recurrent tumor nodules [2].
    Patients with B-cell Lymphomas do not usually require treatment with systemic chemotherapy [3,4].
    By electroporation, permeability of the cancer cells to anti-tumour drugs is increased up to a hundred-fold [5].
    Side effects in their patients were limited to hyperpigmentation in the Electrochemotherapy site.
    A complete response was obtained after 4 weeks, and no relapses were observed during 18-month follow-up.

    Conclusion

    This is the first report describing the use of Electrochemotherapy for the treatment of primary cutaneous B-cell Lymphoma. Whilst the number of treated cases is limited, these results stress that Electrochemotherapy could be considered not just as a palliation, but also as an appealing alternative to standard anti-cancer options [2].

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    References

    1. Gatti A et al. Electrochemotherapy as a novel treatment for primary cutaneous marginal zone B-cell lymphomas. Dermatol Ther. 2014 Jul-Aug;27(4):244-7.
    2. Escoffre JM et al. Electrochemotherapy: progress and prospects. Curr Pharm Des 2012: 18: 3406–3415.
    3. Kempf W et al. Primary cutaneous B-cell lymphomas. J DtschDermatol Ges 2012: 10:12–22.
    4. Sokol L et al. Primary cutaneous B-cell lymphomas: recent advances in diagnosis and management. Cancer Control 2012: 19: 236–244.
    5. Mir LM et al. Standard operating procedures of the Electrochemotherapy: instructions for the use of bleomycin or cisplatin administered either systemically or locally and electric pulses delivered by the Cliniporator (TM) by means of invasive or non-invasive electrodes. EJC Suppl 2006: 4: 14–25.

  • Basal Cell Carcinoma Information

    The role of Electrochemotherapy in the treatment of metastatic basal cell carcinoma

    Introduction

    Electrochemotherapy is a treatment combining a low dose of a chemotherapy drug and an electrical pulse (electroporation) applied directly to the cancer cells using an electrode.

    This low level dose of chemotherapy drug is not normally effective against the cancer, as it is difficult to get inside the cells. When the electrical pulse is applied, the cells form pores allowing the drug to enter and be active against the cancer.

    Electrochemotherapy for basal cell carcinoma patients

    Electrochemotherapy is "an effective and well-tolerated adjunct to the therapeutic options in metastatic basal cell carcinoma (BCC)" [1].

    Metastatic basal cell carcinoma is a rare disease with a poor prognosis. Palliative therapeutic approaches include surgery, radiotherapy and/or chemotherapy. These treatment modalities are invasive and risky and associated with relevant adverse effects.

    Electrochemotherapy is a therapy that relies on the permeation of cancer cell membranes by electrical pulses to enhance cytotoxic drug penetration. A recent study highlights a case of metastatic basal cell carcinoma in which Electrochemotherapy was effective in inducing local regression of skin metastases.

    Clinical experience

    - Electrochemotherapy is an effective and well-tolerated adjunct to the therapeutic options in metastatic basal cell carcinoma, characterized by an advantageous risk-benefi t ratio.
    - Electrochemotherapy has been demonstrated to be an effective and well-tolerated therapy for solid tumours in both experimental and clinical studies. [1, 2]
    - In several clinical trials, Electrochemotherapy with Bleomycin gave the best response rates in basal cell carcinoma among a variety of primary and secondary skin tumours, with a complete response in up to 94.4% of cases after 1 treatment session. [3]
    - There is a potential role of Electrochemotherapy as palliative therapy in metastatic BBC.
    - Electrochemotherapy represents an effective, safe and well-tolerated adjunct to the therapeutic options in diffi cult-to-treat cutaneous tumours.
    - Electrochemotherapy is worthy to be considered in selected cases in which the extension of the lesions or the patient’s conditions contraindicate traditional techniques.

    Conclusion

    Electrochemotherapy is an effective and well-tolerated adjunct to the therapeutic options in metastatic basal cell carcinoma, characterized by an advantageous risk-benefi t ratio and minimal downtime. [3,4]

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    References

    1. Gothelf A et al. Electrochemotherapy: results of cancer treatment using enhanced delivery of bleomycin by electroporation. Cancer Treat Rev. 2003; 29(5):371-387.
    2. Marty M et al. Electrochemotherapy—an easy, highly effective and safe treatment of cutaneous and subcutaneous metastases: results of ESOPE (European Standard Operating Procedures of Electrochemotherapy) study. Eur J Cancer Supplements. 2006;4(11):3-13.
    3. Heller R et al. Treatment of cutaneous and subcutaneous tumors with electrochemotherapy using intralesional bleomycin. Cancer.1998;83(1):148-157.
    4. Fantini F et al. Metastatic Basal Cell Carcinoma With Squamous Differrentiation Report of a Casa With Response of Cutaneous Metastases to Electrochemotherapy. Arch Dermatol. 2008 Sep;144(9):1186-8.

  • Gorlin-Goltz Syndrome Information

    The role of Electrochemotherapy in the treatment of Gorlin-Goltz syndrome

    Introduction

    Electrochemotherapy is a treatment combining a low dose of a chemotherapy drug and an electrical pulse (electroporation) applied directly to the cancer cells using an electrode.

    This low level dose of chemotherapy drug is not normally effective against the cancer, as it is difficult to get inside the cells. When the electrical pulse is applied, the cells form pores allowing the drug to enter and be active against the cancer.

    Electrochemotherapy as "a new treatment option" [1] for Gorlin-Goltz patients

    “We consider Electrochemotherapy to be an additional tool in the therapeutic armamentarium for Gorlin-Goltz syndrome, and suggest using it as early as possible in selected patients to avoid disfiguring scarring.” [1]

    Gorlin-Goltz syndrome is a rare multisystemic disease, characterized by numerous basal cell carcinomas (BCC). The ideal approach for patients with the syndrome would be a treatment with a high cure rate, minimal scarring, short healing time and mild side effects.

    Electrochemotherapy is a therapeutic option that ablates tumours with electrical current and simultaneously administered anti-cancer drugs. Two recent studies have examined the use of Electrochemotherapy to treat this rare syndrome.

    Clinical experience

    - Clinical response was obtained in 99%of the lesions, 87% of them showed complete response.
    - Long-term cosmetic results were excellent.
    - Biopsies were taken 3 months after treatment from two treated lesions, where clinically no residual tumour could be detected.
    - Due to the low doses of Bleomycin used during Electrochemotherapy, no systemic side-effects were observed.
    - Electrochemotherapy might allow tumour antigen shedding and local infl ammation, thus attracting immune antigen-presenting cells.
    - No recurrence was experienced on treated tumours in the follow-up (10–28 months).
    - Numerous tumours can be treated at the same time with curative intent, and sessions can be repeated if necessary. [2]

    Conclusion

    Electrochemotherapy is feasible and effective on unresectable BCCs. The advantages of this therapy are its simplicity, the short duration of treatment sessions, insignifi cant side effects, and repeatability.

    In addition, Electrochemotherapy has the advantage of achieving good local tissue preservation, less scarring and a good cosmetic outcome, thus improving the quality of life. [3] Electrochemotherapy under general sedation is a good choice to treat BCCs in Gorlin-Goltz syndrome, especially in patients presenting with multiple high-risk skin tumours.

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    References

    1. Kis E et al. Successful Treatment of Multiple Basaliomas with Bleomcin-based Electrochemotherapy: A Case Series of Three Patients with Gorlin-Goltz Syndrome. Acta Derm Venereol. 2012 Nov;92(6):648-51.
    2. Glass LF et al. Bleomycin-mediated electrochemotherapy of basal cell carcinoma. J Am Acad Dermatol. 1996;34:82-6.
    3.Curatolo P et al. Electrochemotherapy: a valid treatment for Gorlin-Goltz syndrome. Acta Dermatovenerol Croat. 2013; 21(2):132-3.

     

  • Kaposi Sarcoma Information

    The role of Electrochemotherapy in the treatment of Kaposi Sarcoma

    Introduction

    Electrochemotherapy is a treatment combining a low dose of a chemotherapy drug and an electrical pulse (electroporation) applied directly to the cancer cells using an electrode.

    This low level dose of chemotherapy drug is not normally effective against the cancer, as it is difficult to get inside the cells. When the electrical pulses are applied, the cells form pores allowing the drug to enter and be active against the cancer.

    Electrochemotherapy for Kaposi Sarcoma patients

    The appearance of widespread cutaneous tumoral nodules is a distressing situation for many Kaposi Sarcoma patients.

    The presence of these lesions may unfavourably impact on a patient’s quality of life, in particular if ulceration or bleeding occurs. Two recent studies have highlighted the benefits of using Electrochemotherapy, saying that, “Electrochemotherapy may be considered to be used as a first line therapy for patients with Kaposi Sarcoma”. [1]

    Is Electrochemotherapy the ‘new standard of care’ for Kaposi Sarcoma patients?

    Electrochemotherapy (ECT) is a therapeutic procedure indicated for the local treatment of cutaneous and subcutaneous metastatic lesions, whose efficacy is independent of origin histology and of previous treatments. Side effects associated with the treatment are minimal and the procedure presents a favourable cost benefi t ratio. As such, Electrochemotherapy represents an effective tool for local disease control.

    Clinical experience

    - A response to the first Electrochemotherapy session was obtained in all patients, with a complete response (CR) in 14 (60.9%) of 23 patients.
    - Sustained local control of treated lesions was present in 20 of 23 patients. [2]
    - The absence of systemic adverse effects and the low impact on immunosystem functions also allow the treatment of elderly people with repeated courses.
    - According to RECIST guidelines, a response to the first Electrochemotherapy treatment, scored at 4 weeks, was obtained in all patients.
    - Electrochemotherapy with Bleomycin administration proved successful in the local control of Kaposi Sarcoma skin nodules where other approaches, such as surgery or radiotherapy, would have been hazardous due to the high risk of ulceration, bleeding, infection and delayed healing. [1-4]
    - Curatolo et al. described the complete regression of a case of isolated genital Kaposi Sarcoma after one course of Electrochemotherapy, underlining its effi cacy and high tolerability in diffi cult anatomic sites. [3]

    Conclusion

    The absence of toxicity and the mild general anesthesia needed for Electrochemotherapy treatment permit repeated sessions. Electrochemotherapy has a very low morbidity rate. The procedure is safe, simple, economic and high effective.

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    Information & Support

    References

    1. Di Monta G et al. Electrochemotherapy as “new standard of care” treatment for cutaneous Kaposi’s sarcoma, Eur J Surg Oncol 2014 Jan; 40(1):61-66.
    2. Curatolo P et al. Electrochemotherapy in the Treatment of Kaposi Sarcoma Cutaneous Lesions: A Two-Center Prospective Phase II Trial. Ann Surg Oncol. 2012 Jan; 19(1):192-198.
    3. Curatolo P et al. Successful treatment of penile Kaposi’s sarcoma with electrochemotherapy. Dermatologic Surgery 2008, 34, (6): 839–843.
    4. Latini A et al. Effective treatment of Kaposi’s sarcoma by electrochemotherapy and intravenous bleomycin administration. Dermatologic Therapy 2012, 25(2):214–218.

     

     

     

  • Merkel Cell Carcinoma Information

    The role of Electrochemotherapy in the treatment of advanced Merkel Cell Carcinoma of the head and neck region

    Introduction

    Electrochemotherapy is a treatment combining a low dose of a chemotherapy drug and an electrical pulse (electroporation) applied directly to the cancer cells using an electrode.

    This low level dose of chemotherapy drug is not normally effective against the cancer, as it is difficult to get inside the cells. When the electric pulse is applied, the cells form pores allowing the drug to enter and be active against the cancer.

    Electrochemotherapy for Merkel Cell Carcinoma patients

    Electrochemotherapy as a “new therapeutic strategy in advanced Merkel Cell Carcinoma of the head and neck region”. [1]

    Merkel Cell Carcinoma (MCC) is a rare and aggressive tumour, arising from a cutaneous mechanoceptor cell located in the basal layer of epidermis, with poor prognosis due to the fast local growth and high local recurrence, regional lymph node metastases and distant metastases rates, occurring even after prompt treatment. [2]

    In the last years, Electrochemotherapy has been proposed as a therapeutic weapon for the control of recurrent cutaneous and subcutaneous or mucosal neoplastic lesions of different histologies. Scelsi et al [3] report a case of an 84 year old woman with a recurrent MCC of the chin treated with Electrochemotherapy. During the period of 20 months, four sessions of Electrochemotherapy were employed, which resulted in an objective response of the tumour and a good quality of residual life.

    Clinical experience

    - Good local tumour control was reached with Electrochemotherapy with no signifi cant adverse events, which resulted in a good quality of life.
    - The reported rates of objective response seem promising, ranging from 56% to 100%, depending on the tumour size.
    - Electrochemotherapy is simple to use, highly safe, and an effective treatment with no substantial adverse effects.
    - The post-operative defect is usually less extensive and less disfi guring than that occurring with excisional surgery, thus improving quality of life. [3, 4, 5]

    Conclusion

    This case shows the effectiveness of Electrochemotherapy in the treatment of locally advanced MCC of the head and neck region in a patient not suitable for standard therapeutic options.

    Electrochemotherapy can be considered as an effective palliative treatment option for patients with recurrent or advanced stage tumour. [2, 4, 5] Electrochemotherapy may be an effective alternative to the conventional treatment of MCC.

    Useful Links

    Information & Support

    References

    1. Scelsi D et al. Electrochemotherapy as a new therapeutic strategy in advanced Merkel cell carcinoma of head and neck region. Radiol Oncol. 2013; 47(4):366-369.
    2. Curatolo P et al. Remission of extensive Merkel cell carcinoma after electrochemotherapy. Arch Dermatol 2009; 145: 494-5.
    3. Sersa G. The state-of-the-art of electrochemotherapy before the ESOPE study; advantages and clinical uses. EJC Suppl 2006; 4: 52-9. 8.
    4. Mevio N et al. Electrochemotherapy for the treatment of recurrent head and neck cancers: preliminary results. Tumori 2012; 98: 308-13.
    5. Landström FJ et al. Electroporation therapy of skin cancer in the head and neck area. Dermatol Surg 2010; 36: 1245-50.

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