MADRID — Electrochemotherapy is gaining traction in Europe as palliative therapy for cutaneous metastases in patients with stage III melanoma.
Electrochemotherapy was the subject of numerous presentations at the World Congress on Cancers of the Skin sponsored by the Skin Cancer Foundation, including a plenary overview by Dr. Josep Malvehy of the University of Barcelona.
“Electrochemotherapy is simple, highly effective, safe, and cost effective since it can be done on an outpatient basis. No specific skill is required. A 1-day training at an experienced center is sufficient to let a physician feel confident with the treatment,” he said.
The therapy is based upon the phenomenon of electroporation, in which brief, intense electric pulses are applied to a treatment area to temporarily increase the permeability of cell membranes. This allows entry of previously administered low-dose chemotherapy drugs into the tumor cells. Roughly 20 minutes after application of the electric pulses the channels reseal, trapping the drug within the cells. Intralesional or intravenous bleomycin or intralesional cisplatin are typically used, he explained.
An Italian company, IGEA, has received European marketing approval for its Cliniporator electrochemotherapy system and is now seeking Food and Drug Administration clearance.
In a pivotal European clinical trial—the European Standard Operating Procedures of Electrochemotherapy (ESOPE) study—41 patients were treated for 171 symptomatic cutaneous metastases of melanoma, sarcoma, or carcinoma. There was a 74% complete response and a 10% partial response rate with no significant toxicity (Eur. J. Cancer Supplements 2006;4:3-13).
Those are stellar results for palliation in difficult cases, and they have subsequently been replicated in other studies and born out in clinical experience, Dr. Malvehy said.
He turns to electrochemotherapy for palliation in melanoma patients with inoperable skin or subcutaneous metastases, for metastatic lesions that have progressed despite conventional high-dose chemotherapy, and in patients with truncal lesions or who are otherwise unsuitable for isolated limb perfusion.
The therapy’s major limitation is that efficacy drops off substantially for tumors larger than 3 cm.
Dr. Malvehy noted that, in a cost-effectiveness analysis funded by IGEA, investigators utilizing Italian national health care system data determined that a course of electrochemotherapy for control of cutaneous and subcutaneous tumors averaged 1,408 euro, compared with 1,124 euro for radiotherapy, 14,052 euro for interferon-alpha, 18,530 euro for isolated limb perfusion, and 2,089 euro for hyperthermia in combination with chemotherapy and radiotherapy (Ther. Clin. Risk Manag. 2008;4:541-8).
“In our clinic we’re now using electrochemotherapy to take on difficult head and neck cancers that are inoperable and have no response to chemotherapy or radiotherapy. Our preliminary results are really very good,” he said.<[qm]>
Dr. Malvehy reported no financial conflicts.