Electrochemotherapy

Why electrochemotherapy

Electrochemotherapy stands out as one of the most effective, cost-efficient, and minimally invasive treatments in oncology. This technique involves administering cytostatic drugs either directly into the tumor or into the bloodstream, followed by the application of electric pulses. This process, termed electroporation, specifically targets cancer cells. A specialized probe delivers an electrical impulse to the malignant tumor, modifying the cancer cell membrane to create pores. These pores facilitate the entry of the medication, enhancing its effectiveness exclusively on cancer cells.

In preclinical studies, bleomycin and cisplatin have emerged as the drugs of choice for clinical applications in electrochemotherapy. The introduction of electric pulses significantly escalates the cytotoxic power of bleomycin, by nearly 10,000 times. The delivery of these pulses to tumors can be achieved using either plate electrodes placed on the skin above the tumor or needle electrodes inserted directly into it. The application of these electric pulses, irrespective of the electrode type used, has little to no impact on healthy tissue, ensuring a targeted approach to tumor treatment.

The Efficacy of
Electrochemotherapy
in Cancer Treatment

Electrochemotherapy has been demonstrated to be more effective compared to just administering cytostatic drugs. This method holds promise for treating malignant tumors of both skin and non-skin origins. Research indicates that small tumors have a response rate that is twice as high as that of larger tumors. Additionally, electrochemotherapy is a cost-effective, quicker, and more bearable approach for treating various tumor types. This is because the use of lower doses of cytostatic drugs leads to fewer side effects and less discomfort.

In terms of objective response rate (ORR), electrochemotherapy achieves over 80%, with a substantial proportion (53-86%) of these responses being complete and enduring. Recent data suggests an average effectiveness of around 84% for electrochemotherapy. In contrast, systemic chemotherapy, especially for stage four cancers, often serves a palliative function with response rates falling below 25% when used as monotherapy. Thus, the enhanced delivery of chemotherapeutic agents into tumor cells via electroporation emerges as a critical and potentially life-saving strategy. This method achieves significantly higher intracellular concentrations of bleomycin or cisplatin in tumor cells, using far smaller doses than traditional chemotherapy. This not only boosts their antitumor effectiveness but also preserves the integrity of normal cells, which are no longer adversely affected as they might be in conventional chemotherapy.

This technique notably enhances the concentration of chemotherapeutic drugs within the tumor tissue, allowing for the use of much smaller drug doses. This reduction in dosage significantly minimizes side effects. The primary benefit of electrochemotherapy lies in its ability to spare healthy tissue, setting it apart from traditional oncological treatments.

Electrochemotherapy is compatible with various other treatments like chemotherapy, radiotherapy, or supportive therapies, without causing any interference. In fact, it enhances the efficacy of all other cancer treatments. When the immune system is robust, undergoing electrochemotherapy can yield considerable advantages. In certain instances, this can result in the total elimination of the tumor and effectively halt the spread of metastases.

It is effective in reducing tumor masses, shrinking affected lymph nodes, alleviating local pain, and thereby improving the patient's quality of life. Furthermore, it offers a viable option for treating tumors that are resistant to other therapies and can be integrated into combined treatment plans.

European Approval of Electrochemotherapy

In use for over 25 years across Europe, electrochemotherapy is supported by numerous clinical studies and has even been incorporated into European treatment guidelines. It is primarily used with bleomycin and cisplatin for treating cutaneous metastases from various tumors and inoperable primary tumors.

Benefits

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
Electro- chemotherapy

Electrochemotherapy not only demonstrates a direct cytotoxic effect on cancer cells but also incites a systemic anticancer immune response through the activation of immunogenic cell death. This positions electrochemotherapy as a local immune response initiator, functioning akin to an in-situ vaccination with body-wide immunogenic impacts. The result is a more comprehensive and enduring antitumor effect, extending even to metastases that haven't undergone electroporation.

Consequently, a robust immune response is pivotal in this therapy, amplifying the immunogenic effects of electrochemotherapy ²¹. This encompasses both a sufficient quantity of immune cells, including T cells, NK cells, and Dendritic cells, and the integration of specific immune-boosting therapies. Research indicates a significant synergistic effect of electrochemotherapy when combined with immunotherapy ²², particularly in immunogenic tumors like melanoma ²³, breast cancer ²⁴, and liver cancer ²⁵.