What is Electrochemotherapy?
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.
Who is suitable for treatment?
Electrochemotherapy is suitable for patients presenting with:
- Metastatic melanoma on the skin
- In transit metastases irrespective of pathologies
- Squamous cell carcinomas
- Basal cell carcinomas
- Kaposi’s sarcomas
- Head and neck cancers
- Gynaecological cancers
- Breast cancers that are affecting the skin
Can Electrochemotherapy be repeated?
Electrochemotherapy can be repeated as necessary, to improve the response to the treatment or to control any new cancer nodules that appear.
Does Electrochemotherapy have NICE guidance?
NICE published guidance on Electrochemotherapy in March 2013 and July 2015, saying that it may reduce symptoms and improve quality of life for appropriately selected patients.
NICE has said that this procedure can be: ’offered routinely as a palliative treatment option for people with metastases in the skin from tumours of non-skin origin or melanoma… the procedure may reduce symptoms and improve quality of life or people with disease that cannot be treated with, or doesn’t respond to, other treatments. If palliative surgery is not feasible for people with in-transit metastases, consider…Electrochemotherapy in line with NICE’s interventional procedure guidance on Electrochemotherapy for metastases in the skin from tumours of non-skin origin and melanoma.’
What about Bleomycin toxicity and lung fibrosis?
The following checks need to be carried out before the Electrochemotherapy procedure is performed:
Check that the patient is fit for general anaesthetic
Perform a lung function test, as a potential side effect of Bleomycin is lung fibrosis
Can the patient be treated under local sedation?
98% of our patients are treated under general anaesthetic. However, the procedure can be carried out under local anaesthetic, either with or without sedation.
Can Electrochemotherapy patients be treated as day case?
Patients are often treated as a day case, and treatment with Electrochemotherapy does not usually involve an overnight stay in hospital. Of course, this must be assessed on a patient-by-patient basis and in some cases it may be more appropriate to keep the patient under surveillance for the night after the operation.
What side effects are there?
Some patients may experience a mild fever following the treatment, but medication can be prescribed to relieve this. On rare occasions, the wound site may become infected. Signs to look out for around the wound site include increased redness and pain, discharge or fluid leakage.
Serious side effects are extremely rare but, as with all medical interventions, can happen. In very few cases, patients may have an allergic reaction to the chemotherapy drug or may experience shortness of breath. This is why it is important to have any relevant investigations before the day of treatment.
Is it purely palliative?
This is dependent upon the size of tumours that the patient is presenting with.
With tumours that are presenting as less than 3 cm there is a good chance that Electrochemotherapy treatment can shrink these completely, so that the patient has disease-free skin.
However, with patients who present with larger bleeding or fungating wounds, then treatment is to provide comfort and a greater quality of life.
How many UK centres do you have?
There are currently 13 centres in the UK that offer treatment with Electrochemotherapy.
In addition to this, IGEA UK are in talks with a number of other hospital trusts and plans are in place to install machines in a number of other centres throughout the UK.
How many patients have been treated?
In 2014, over 300 people were treated with Electrochemotherapy in the UK.
Is the treatment reimbursed? What is your tariff?
We do not have a specific tariff for Electrochemotherapy but NHS England are currently working on this.
However, there is a code that covers the cost of the procedure and this is regularly used by hospitals. OPCS-4.7 code Y12.3.
Can you use Electrochemotherapy with radiotherapy?
As Electrochemotherapy is a localised treatment, it can be used safely in conjunction with other treatments such as radiotherapy.
Why use Bleomycin? Can you use other more effective drugs?
During the development of the electroporation treatment, a number of cancer drugs were considered and trialled.
Bleomycin with electroporation gave a 1000-fold increase in effect, making it the most effective choice for the Electrochemotherapy treatment. It works as a strong DNA cutting agent making it a very effective anti-cancer drug, with strong defence against its own resistance.
Bleomycin is also active against cancers of any histology providing it can get into the cell, which electroporation allows it to do.
Bleomycin is not costly cancer drug and this makes Electrochemotherapy a cost-effective cancer treatment.
Cisplatin can be used if Bleomycin is unsuitable, for example if the maximum safe dose of Bleomycin has been exceeded or if there have been unacceptable side effects from Bleomycin.
Do you have survival data?
We don’t have any published survival data at present but we are aware of specific patients that have been treated, and that these patients have a better prognosis than if they hadn’t received the treatment.
We do have Local tumour control – showing progression-free survival at 81% at 3 years in a phase II study.
Is there a thermal effect from the needles? Does it burn the patient?
As a bi-polar needle is used during the electroporation process, the electricity flows in and out through the electrode. Therefore, whilst you will initially see some discolouration marks on the skin, these should fade during the healing process.
During the healing phase, you will see a mark on the skin where the needles have entered. However, these normally fade over time and long term scarring from the needles is not expected.
Can Electrochemotherapy be used if the patient has a pacemaker?
If a patient has a pacemaker, then treatment should not be given in areas that are in close proximity to the pacemaker.
Patients with pacemakers have been treated with Electrochemotherapy, care and guidance from IGEA UK is available.
Do you have published clinical data?
We have a plethora of clinical papers that support our 85% objective response rate following the treatment.
Please go to Information and Support to find out more.
Do you have long-term results?
As treatments that have been given to date are relatively few, long-term results are ongoing.
Our Inspect Registry group are currently collating this very data.