Electrochemotherapy

Advantages of Using Electrochemotherapy

Through this method, the concentration of the chemotherapeutic drug in the tumor tissue is significantly increased, which is why the cytostatic is administered in much smaller doses. This leads to a reduction in side effects. Thus, the main advantage of this procedure is that it preserves healthy tissue unaffected, compared to other options for classical oncological treatment. Electrochemotherapy can reduce tumor masses to disappearance, can lead to the reduction in the size of affected lymph nodes, diminish or even eliminate local pain, and thus improves the quality of life. Also, it can treat tumors that do not respond well to other forms of treatment and can be used in combination with other therapies. Is This Therapy Approved in Europe?

This technique, which has been used for over 25 years in Europe, benefits from many clinical studies and even includes a European treatment guideline. Electrochemotherapy currently uses bleomycin and cisplatin to treat cutaneous metastases of various tumors, as well as inoperable primary tumors.

Effects of Electroporation

• Selective destruction of tumor tissues.
• Major and irreversible damage to the blood vessels that nourish the tumor with nutrients and oxygen, leading to the death of tumor cells [2].
• Immunogenic effect in destroying distant metastases through the abscopal effect.

How Many Sessions Are Needed?

Generally, a single session is sufficient. This can trigger an abscopal immunogenic effect whereby the immune system destroys other metastases. However, in cases of larger tumors, a second session may be necessary.

 Through the courtesy of Dr. Gregor Sersa

What are the cancers where electrochemotherapy is indicated?

• Melanoma [3], especially recurrent or metastatic.
• Skin cancer, such as basal cell carcinoma [4] and squamous cell carcinoma [5].
• Breast cancer [6], particularly in cases that have proven resistant to other treatments recommended by guidelines. Studies show a complete response in 50% of cases, partial response in 21%, stable disease in 18%, and progression in only 8% of cases [7].
• Recurrence at the chest wall in breast cancer, where a complete cure rate of 59% is recorded and an objective response rate of 89% is even higher than on primary tumors in breast cancer.
  
• Bone metastases [8], where studies have recorded a response rate of 29%, stable disease in 59%, and progression in only 16%. The mineral structure of the bone and its regenerative capacity are not affected.
• Sarcoma [9] can be treated by electrochemotherapy, especially when located in the skin or soft tissues.
• Squamous cell carcinoma of the oral cavity and oropharynx [10].
• Head and neck tumors [11], or those located at this level.
• Rectal cancer [12].
• Cutaneous metastases [13], of any histology, which are symptomatic due to bleeding, ulceration, breathing, smell, or pain.
• Primary mucosal cancers [14], including recurrent tumors, where other treatment modalities (surgery, radiotherapy, systemic therapies) have failed or are not possible.
• Primary unresectable pancreatic cancer [15].
• Liver metastases [16] from solid tumors.
• Cholangiocellular carcinoma [17] at the hepatic hilum.
• Hepatocellular carcinoma [18].
• Salivary gland cancer [19].
• Esophageal cancer [20].

Contraindications for electrochemotherapy

• Allergy or hypersensitivity to bleomycin or Cisplatin.
• Cumulative dose of bleomycin of 400,000 IU.
• Peripheral neuropathy > grade 2.
• History of pulmonary fibrosis will prevent intravenous administration of bleomycin.
• Infection and/or heart failure and/or liver failure and/or other serious systemic diseases.
• Severe uncorrectable coagulation disorders.
• Pregnancy, breastfeeding: potentially fertile patients must use appropriate contraceptive methods.

Clinical Benefit of Electrochemotherapy

Disease Control

• Objective response rate greater than 80%.
• High percentage (53-86%) of long-lasting complete responses

Symptoms to be mitigated by ECT

• Bleeding
• Discharge
• Pain
• Smell   

Other advantage

• Safe, easy, and extremely effective treatment.
• Improvement in the patient's quality of life, regardless of life expectancy.
• Positive cosmetic and functional results.
• Electrochemotherapy is independent of histology.
• Small doses of medication.
• No significant side effects.
• Can be safely repeated multiple times, and patients are willing to undergo repeat treatments.
• Cost-effectiveness

Immunogenic Effect of Electrochemotherapy

Electrochemotherapy not only possesses intrinsic cytotoxic capacity against cancer cells but also generates a systemic anticancer immune response by activating immunogenic cell death. Thus, electrochemotherapy can be considered to trigger a local immune response and act as an in-situ vaccination with immunogenic effects throughout the body. This results in a more effective and long-lasting antitumor effect even in metastases that have not been electroporated.

Therefore, a strong immune response is essential in this therapy to amplify the immunogenic effects of electrochemotherapy. This should mean both a sufficient number of immune cells, T, NK, and Dendritic cells, and subsequent support of the therapy with specific immune-strengthening therapies. In this regard, studies show a strong synergy of electrochemotherapy with immunotherapy [22], especially in immunogenic tumors such as melanoma [23], breast cancer [24], liver cancer [25], etc.

ImunoMedica Clinic is the only place in Roumania where electrochemotherapy is used in the treatment of cancer. The equipment we use is the latest generation, the most efficient in the field of electroporation. Most of the clinical and preclinical studies in the field of electrochemotherapy have been conducted using this equipment - IGEA.

To find out if you are eligible for electrochemotherapy treatment for the cancer you are suffering from, you can schedule an appointment at our clinic with Dr. Valentin Popescu, one of the few specialists in this field in Romania. 

Bibliography

24. Denkert, Carsten. "The immunogenicity of breast cancer—molecular subtypes matter." Annals of Oncology 25.8 (2014): 1453-1455; Loizides, Sotiris, and Anastasia Constantinidou. "Triple negative breast cancer: Immunogenicity, tumor microenvironment, and immunotherapy." Frontiers in Genetics 13 (2023): 1095839.
25. Trotovšek, Blaž, et al. "New era of electrochemotherapy in treatment of liver tumors in conjunction with immunotherapies." World Journal of Gastroenterology 27.48 (2021): 8216; Trotovsek, Blaz, et al. "Laparoscopic electrochemotherapy for the treatment of hepatocellular carcinoma: Technological advancement." Frontiers in Oncology 12 (2022): 996269.