electrochemotherapy

Last reviewed 01/2018

Electrochemotherapy is a local treatment that aims to enhance the effects of chemotherapy

  • electrochemotherapy is a local treatment of cancer which combines the use of a medical device with pharmaceutical agents to achieve local tumor control in solid cancers
    • procedure consists of applying short high-intensity pulsed electric fields to cells, in response to which, the plasma membrane's permeability to various molecules transiently increases
      • facilitates cellular uptake of cytotoxic agents, thus increasing their cytotoxicity
      • treatment is based on the phenomenon termed electroporation, which occurs, when externally delivered electric field induces a sufficiently large transmembrane voltage
        • electroporation is, in addition to its use in electrochemotherapy, used also as non-viral gene delivery method to cells in vitro and in vivo-gene electrotransfer
        • furthermore, electroporation as sole modality can be used as tumor ablation in the form of irreversible electroporation, also referred to as non-thermal irreversible electroporation

  • procedure is performed with the patient under general or local anaesthesia with or without sedation

  • chemotherapy drugs are given first, either intravenously or directly into the tumour. Drug dose is individualised based on either body surface area or tumour volume

  • shortly after drug administration, brief and intense electric pulses are delivered around or directly into the tumour using either surface plates or needle electrodes
    • makes the cell membranes more permeable to the chemotherapy drugs so that their cytotoxic effect is increased
    • different-shaped plates or electrodes are used depending on the tumour size, extent, shape and location
    • treatment duration may vary depending on the number and size of tumours
      • larger tumours may need several applications to cover the entire surface
      • repeated treatments can be performed if necessary (within the lifetime dose limits of the chemotherapy drugs)

NICE state that "...Current evidence on the safety of electrochemotherapy for primary basal cell carcinoma (BCC) and primary squamous cell carcinoma (SCC) raises no major concerns. Evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and local audit, and with submission of data to a register.."

NICE also suggest that "..

  • sufficient evidence of efficacy of electrochemotherapy for treating metastases in the skin from tumours of non-skin origin and melanoma to support its use as a palliative treatment.." (4)

Notes:

  • electrochemotherapy has been demonstrated to be highly effective in treatment of cutaneous and subcutaneous tumors. Unique properties of electrochemotherapy (e.g., high specificity for targeting cancer cells, high degree of localization of treatment effect, capacity for preserving the innate immune response and the structure of the extracellular matrix) are facilitating its wide spread use (3)

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chemotherapy