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Electrochemotherapy of Breast Cancer

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Breast Cancer

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Abstract

Electrochemotherapy is an emerging, minimally invasive treatment modality for unresectable skin tumors and cutaneous metastases. It combines the administration of a cytotoxic agent, bleomycin, or cisplatin, with the local application of brief electric pulses, in order to permeabilize tumor cell membrane and achieve effective drug delivery. The first clinical experiences in the treatment of cutaneous metastases from breast cancer date back to the 1990s and reported an objective response rate up to 90%, with 59% of patients achieving complete response. In 2006, the procedure was standardized, with adoption of the European Standard Operating Procedures for Electrochemotherapy (ESOPE). Based on this protocol, drugs can be administered either intratumorally or intravenously, depending on tumor burden; the procedure can be performed under local or general anesthesia and lasts 20–30 min, thus allowing prompt patient recovery. After standardization, electrochemotherapy resulted in complete response rate ranging from 26% to 58%, depending on tumor size, with durable local control. Due to its tolerability and favorable toxicity profile, treatment can be safely repeated, also in frail patients. In a recently published multicenter study including 125 patients, small tumor size, hormone receptor positivity, low proliferative index, and absence of visceral metastases were predictors of response to treatment. Electrochemotherapy represents a promising treatment modality for patients with locoregional recurrence (i.e., skin-only recurrence) from breast cancer and for metastatic patients with symptomatic skin tumor involvement. Ongoing studies have to confirm these promising findings and to explore electrochemotherapy in different stages of disease as well as in combination with systemic therapies.

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References

  1. Sersa G et al (2008) Electrochemotherapy in treatment of tumours. Eur J Surg Oncol 34(2):232–240

    Article  CAS  PubMed  Google Scholar 

  2. Testori A et al (2010) Electrochemotherapy for cutaneous and subcutaneous tumor lesions: a novel therapeutic approach. Dermatol Ther 23(6):651–661

    Article  PubMed  Google Scholar 

  3. Yarmush ML et al (2014) Electroporation-based technologies for medicine: principles, applications, and challenges. Annu Rev Biomed Eng 16:295–320

    Article  CAS  PubMed  Google Scholar 

  4. Miklavcic D et al (2014) Electrochemotherapy: from the drawing board into medical practice. Biomed Eng Online 13(1):29

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mir LM et al (1991) Electrochemotherapy potentiation of antitumour effect of bleomycin by local electric pulses. Eur J Cancer 27(1):68–72

    Article  CAS  PubMed  Google Scholar 

  6. Kanthou C et al (2006) The endothelial cytoskeleton as a target of electroporation-based therapies. Mol Cancer Ther 5(12):3145–3152

    Article  CAS  PubMed  Google Scholar 

  7. Sersa G et al (2002) Reduced blood flow and oxygenation in SA-1 tumours after electrochemotherapy with cisplatin. Br J Cancer 87(9):1047–1054

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Sersa G et al (2008) Vascular disrupting action of electroporation and electrochemotherapy with bleomycin in murine sarcoma. Br J Cancer 98(2):388–398

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Markelc B, Sersa G, Cemazar M (2013) Differential mechanisms associated with vascular disrupting action of electrochemotherapy: intravital microscopy on the level of single normal and tumor blood vessels. PLoS One 8(3):e59557

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Calvet CY et al (2014) Electrochemotherapy with bleomycin induces hallmarks of immunogenic cell death in murine colon cancer cells. Oncoimmunology 3:e28131

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sersa G et al (1997) Electrochemotherapy with CDDP on LPB sarcoma: comparison of the anti-tumor effectiveness in immunocompetent and immunodeficient mice. Bioelectrochem Bioenerg 43(2):279–283

    Article  CAS  Google Scholar 

  12. Quaglino P et al (2011) FoxP3 expression on melanoma cells is related to early visceral spreading in melanoma patients treated by electrochemotherapy. Pigment Cell Melanoma Res 24(4):734–736

    Article  CAS  PubMed  Google Scholar 

  13. Sersa G et al (2015) Electrochemotherapy of tumors as in situ vaccination boosted by immunogene electrotransfer. Cancer Immunol Immunother 64(10):1315–1327

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. O'Brien MA et al (2014) Local tumour ablative therapies: opportunities for maximising immune engagement and activation. Biochim Biophys Acta 1846(2):510–523

    PubMed  Google Scholar 

  15. Marty M et al (2006) Electrochemotherapy - an easy, highly effective and safe treatment of cutaneous and subcutaneous metastases: results of ESOPE (European Standard Operating Procedures of Electrochemotherapy) study. EJC Suppl 4(11):3–13

    Article  CAS  Google Scholar 

  16. Mir LM et al (2006) Standard operating procedures of the electrochemotherapy: Instructions for the use of bleomycin or cisplatin administered either systemically or locally and electric pulses delivered by the Cliniporator (TM) by means of invasive or non-invasive electrodes. EJC Suppl 4(11):14–25

    Article  CAS  Google Scholar 

  17. Campana LG et al (2014) Bleomycin electrochemotherapy in elderly metastatic breast cancer patients: clinical outcome and management considerations. J Cancer Res Clin Oncol 140(9):1557–1565

    Article  CAS  PubMed  Google Scholar 

  18. Campana LG et al (2014) Electrochemotherapy in non-melanoma head and neck cancers: a retrospective analysis of the treated cases. Br J Oral Maxillofac Surg 52(10):957–964

    Article  PubMed  Google Scholar 

  19. Belehradek M et al (1993) Electrochemotherapy, a new antitumor treatment. First clinical phase I-II trial. Cancer 72(12):3694–3700

    Article  CAS  PubMed  Google Scholar 

  20. Domenge C et al (1996) Antitumor electrochemotherapy: new advances in the clinical protocol. Cancer 77(5):956–963

    Article  CAS  PubMed  Google Scholar 

  21. Larkin JO et al (2007) Electrochemotherapy: aspects of preclinical development and early clinical experience. Ann Surg 245(3):469–479

    Article  PubMed  PubMed Central  Google Scholar 

  22. Quaglino P et al (2008) Electrochemotherapy with intravenous bleomycin in the local treatment of skin melanoma metastases. Ann Surg Oncol 15(8):2215–2222

    Article  CAS  PubMed  Google Scholar 

  23. Campana LG et al (2009) Bleomycin-based electrochemotherapy: clinical outcome from a single institution’s experience with 52 patients. Ann Surg Oncol 16(1):191–199

    Article  PubMed  Google Scholar 

  24. Matthiessen LW et al (2012) Electrochemotherapy for large cutaneous recurrence of breast cancer: a phase II clinical trial. Acta Oncol 51(6):713–721

    Article  PubMed  Google Scholar 

  25. Mali B et al (2013) Tumor size and effectiveness of electrochemotherapy. Radiol Oncol 47(1):32–41

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jarm T et al (2010) Antivascular effects of electrochemotherapy: implications in treatment of bleeding metastases. Expert Rev Anticancer Ther 10(5):729–746

    Article  PubMed  Google Scholar 

  27. Kubota Y et al (1998) Successful treatment of metastatic skin lesions with electrochemotherapy. J Urol 160(4):1426

    Article  CAS  PubMed  Google Scholar 

  28. Gehl J, Geertsen PF (2000) Efficient palliation of haemorrhaging malignant melanoma skin metastases by electrochemotherapy. Melanoma Res 10(6):585–589

    Article  CAS  PubMed  Google Scholar 

  29. Snoj M et al (2009) Limb sparing treatment of bleeding melanoma recurrence by electrochemotherapy. Tumori 95(3):398–402

    PubMed  Google Scholar 

  30. Mir LM et al (1998) Effective treatment of cutaneous and subcutaneous malignant tumours by electrochemotherapy. Br J Cancer 77(12):2336–2342

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Quaglino P et al (2015) Predicting patients at risk for pain associated with electrochemotherapy. Acta Oncol 54(3):298–306

    Article  CAS  PubMed  Google Scholar 

  32. Campana LG et al (2012) The activity and safety of electrochemotherapy in persistent chest wall recurrence from breast cancer after mastectomy: a phase-II study. Breast Cancer Res Treat 134(3):1169–1178

    Article  CAS  PubMed  Google Scholar 

  33. Mali B et al (2013) Antitumor effectiveness of electrochemotherapy: a systematic review and meta-analysis. Eur J Surg Oncol 39(1):4–16

    Article  CAS  PubMed  Google Scholar 

  34. Spratt DE et al (2014) Efficacy of skin-directed therapy for cutaneous metastases from advanced cancer: a meta-analysis. J Clin Oncol 32(28):3144–3155

    Article  PubMed  PubMed Central  Google Scholar 

  35. Matthiessen LW et al (2011) Management of cutaneous metastases using electrochemotherapy. Acta Oncol 50(5):621–629

    Article  PubMed  PubMed Central  Google Scholar 

  36. Heller R et al (1996) Phase I/II trial for the treatment of cutaneous and subcutaneous tumors using electrochemotherapy. Cancer 77(5):964–971

    Article  CAS  PubMed  Google Scholar 

  37. Yamamoto T (2006) Bleomycin and the skin. Br J Dermatol 155(5):869–875

    Article  CAS  PubMed  Google Scholar 

  38. Sleijfer S (2001) Bleomycin-induced pneumonitis. Chest 120(2):617–624

    Article  CAS  PubMed  Google Scholar 

  39. Rodriguez-Cuevas S et al (2001) Electrochemotherapy in primary and metastatic skin tumors: phase II trial using intralesional bleomycin. Arch Med Res 32(4):273–276

    Article  CAS  PubMed  Google Scholar 

  40. Sersa G et al (2012) Electrochemotherapy of chest wall breast cancer recurrence. Cancer Treat Rev 38(5):379–386

    Article  PubMed  Google Scholar 

  41. Benevento R et al (2012) Electrochemotherapy of cutaneous metastastes from breast cancer in elderly patients: a preliminary report. BMC Surg 12(Suppl. 1):S6

    Article  PubMed  PubMed Central  Google Scholar 

  42. Cabula C et al (2015) Electrochemotherapy in the treatment of cutaneous metastases from breast cancer: a multicenter cohort analysis. Ann Surg Oncol 22(Suppl. 3):442–450

    Article  PubMed Central  Google Scholar 

  43. Cardoso F et al (2014) ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2)dagger. Ann Oncol 25(10):1871–1888

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Cardoso F et al (2012) Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl. 7):vii11–vii19

    PubMed  Google Scholar 

  45. Katz A et al (2000) Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol 18(15):2817–2827

    Article  CAS  PubMed  Google Scholar 

  46. Overgaard M et al (1997) Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b trial. N Engl J Med 337(14):949–955

    Article  CAS  PubMed  Google Scholar 

  47. Fisher B et al (1996) Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors. J Natl Cancer Inst 88(21):1529–1542

    Article  CAS  PubMed  Google Scholar 

  48. Buchanan CL et al (2006) Locoregional recurrence after mastectomy: incidence and outcomes. J Am Coll Surg 203(4):469–474

    Article  PubMed  Google Scholar 

  49. Cabula C (2013) Neoadjuvant electrochemotherapy of breast cancer: our experience on first case treated in Italy. Updates Surg 65(4):325–328

    Article  PubMed  Google Scholar 

  50. Campana LG et al (2012) Electrochemotherapy for disseminated superficial metastases from malignant melanoma. Br J Surg 99(6):821–830

    Article  CAS  PubMed  Google Scholar 

  51. Valpione S et al (2015) Consolidation electrochemotherapy with bleomycin in metastatic melanoma during treatment with dabrafenib. Radiol Oncol 49(1):71–74

    Article  PubMed  PubMed Central  Google Scholar 

  52. Miklavcic D et al (2010) Towards treatment planning and treatment of deep-seated solid tumors by electrochemotherapy. Biomed Eng Online 9:10

    Article  PubMed  PubMed Central  Google Scholar 

  53. Miklavcic D et al (2012) Electrochemotherapy: technological advancements for efficient electroporation-based treatment of internal tumors. Med Biol Eng Comput 50(12):1213–1225

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Fini M et al (2013) Electrochemotherapy is effective in the treatment of rat bone metastases. Clin Exp Metastasis 30(8):1033–1045

    Article  CAS  PubMed  Google Scholar 

  55. Edhemovic I et al (2014) Intraoperative electrochemotherapy of colorectal liver metastases. J Surg Oncol 110(3):320–327

    Article  PubMed  Google Scholar 

  56. Marcan M et al (2015) Web-based tool for visualization of electric field distribution in deep-seated body structures and planning of electroporation-based treatments. Biomed Eng Online 14(Suppl. 3):S4

    Article  PubMed  PubMed Central  Google Scholar 

  57. Pavliha D et al (2013) Electroporation-based treatment planning for deep-seated tumors based on automatic liver segmentation of MRI images. PLoS One 8(8):e69068

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Kos B et al (2010) Robustness of treatment planning for electrochemotherapy of deep-seated tumors. J Membr Biol 236(1):147–153

    Article  CAS  PubMed  Google Scholar 

  59. Campana LG, Dughiero F, Forzan M, Rossi CR, Sieni E (2015) Prototype of a flexible grid electrode to treat large surfaces by means of electrochemotherapy. In: Abstracts of the 1st World Congress on Electroporation and Pulsed Electric Fields in Biology, Medicine and Food & Environmental Technologies, Portoroz, Slovenja, September 6–10, 2015

    Google Scholar 

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Acknowledgments

The Slovenian Research Agency has supported this research by grant P3-0003. Research was conducted in the scope of the EBAM European Associated Laboratory (LEA) and resulted from the networking efforts of the COST Action TD1104 (www.electroporation.net).

Author information

Authors and Affiliations

  1. Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy

    Luca G. Campana

  2. Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy

    Luca G. Campana

  3. Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark

    Louise Wichmann Matthiessen

  4. Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia

    Marko Snoj

  5. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    Marko Snoj

  6. Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia

    Gregor Sersa

Authors
  1. Luca G. Campana
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  2. Louise Wichmann Matthiessen
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  3. Marko Snoj
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  4. Gregor Sersa
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Corresponding author

Correspondence to Gregor Sersa .

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Editors and Affiliations

  1. European Institutee of Oncology, Milan, Italy

    Umberto Veronesi

  2. European Institute of Oncology, Milan, Italy

    Aron Goldhirsch

  3. European Institute of Oncology, Milan, Italy

    Paolo Veronesi

  4. San Raffaele University and Research Hospital, Milano, Italy

    Oreste Davide Gentilini

  5. European Institute of Oncology, Milan, Italy

    Maria Cristina Leonardi

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Campana, L.G., Matthiessen, L.W., Snoj, M., Sersa, G. (2017). Electrochemotherapy of Breast Cancer. In: Veronesi, U., Goldhirsch, A., Veronesi, P., Gentilini, O., Leonardi, M. (eds) Breast Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-48848-6_76

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  • DOI: https://doi.org/10.1007/978-3-319-48848-6_76

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-48848-6

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