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Bleomycin electrochemotherapy in elderly metastatic breast cancer patients: clinical outcome and management considerations

  • Original Article – Clinical Oncology
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Abstract

Purpose

To evaluate the efficacy and toxicity of electrochemotherapy (ECT) in elderly metastatic breast cancer (BC) patients.

Methods

Retrospective analysis of 55 patients with superficial metastases who underwent ECT according to the European Standard Operative Procedures of electrochemotherapy. Treatment schedule consisted of intravenous or intratumoral bleomycin followed by locally delivered electric pulses. Statistical comparisons were performed between two groups: the patients aged <70 years (n = 27) and those ≥70 years (n = 28). Treatment outcomes were as follows: complete response (CR) rate, local progression-free survival (LPFS), new lesions-free survival (NLFS), toxicity and patient compliance.

Results

Patient groups were comparable for clinical–pathological features, except for the number of comorbidities (P < .001). The median follow-up was 32 months (range 6–53). Overall, CR rate was 40 % and was significantly higher in elderly patients (57 vs. 26 %, P = .023) and in patients with better performance status (PS = 0–1, 53 vs. PS = 2, 21 %, P = .048), although local tumor control showed a trend for lower values (2-year LPFS, 67 vs. 93 % among elderly and young patients, respectively; P = .061). Older women seemed less likely to progress outside the ECT field (2-year NLFS, 39 vs. 30 %, P = .075), but discontinued treatment more frequently due to impaired performance status (P = .002). Local pain was graded ≥3, according to a 10-point visual analog scale, by 16/28 (57.1 %) and 8/28 (28.6 %) elderly patients at 4 and 8 weeks, respectively. Wound debridement was required in 5/28 (18 %) older women, due to G3 skin ulceration.

Conclusions

Elderly BC patients are highly responsive to ECT and achieve durable local tumor control. Physicians should be aware of possible debilitating side effects, such as pain and skin toxicity. Performance status and frailty screening could be a helpful addition to improve patient selection.

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References

  • Alcaraz I, Cerroni L, Rutten A et al (2012) Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review. Am J Dermatopathol 34:347–393

    Article  PubMed  Google Scholar 

  • Bajetta E, Procopio G, Celio L et al (2005) Safety and efficacy of two different doses of capecitabine in the treatment of advanced breast cancer in older women. J Clin Oncol 23:1–7

    Article  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

  • Biganzoli L, Wildiers H, Oakman C et al (2012) Management of elderly patients with breast cancer: updated recommendations of the international society of geriatric oncology (SIOG) and European society of breast cancer specialists (EUSOMA). Lancet Oncol 13:e148–e160

    Article  PubMed  Google Scholar 

  • Brunello A, Fontana A, Zafferri V et al (2013) Validation of a cancer-specific oncological-multidimensional prognostic index (Onco-MPI) for mortality prediction in older cancer patients. J Clin Oncol 31 suppl; abstr 6593

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

    Article  PubMed  Google Scholar 

  • Campana LG, Valpione S, Falci C 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 134:1169–1178

    Article  CAS  PubMed  Google Scholar 

  • Extermann M, Hurria A (2007) Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol 25:1824–1831

    Article  PubMed  Google Scholar 

  • Fernandez-Anton Martinez MC, Parra-Blanco V, Aviles Izquierdo JA et al (2013) Cutaneous metastases of internal tumors. Actas Dermosifiliogr 104:841–853

    Article  CAS  PubMed  Google Scholar 

  • Gerber B, Freund M, Reimer T (2010) Recurrent breast cancer: treatment strategies for maintaining and prolonging good quality of life. Dtsch Arztebl Int 107:85–91

    PubMed Central  PubMed  Google Scholar 

  • Hachisuka J, Doi K, Furue M (2012) Combination cryosurgery with hyperthermia in the management of skin metastasis from breast cancer: a case report. Int J Surg Case Rep 3:68–69

    Article  PubMed Central  PubMed  Google Scholar 

  • Hanson LC, Muss HB (2010) Cancer in the oldest old: making better treatment decisions. J Clin Oncol 28:1975–1976

    Article  PubMed  Google Scholar 

  • Hu SC, Chen GS, Wu CS et al (2009) Rates of cutaneous metastases from different internal malignancies: experience from a Taiwanese medical center. J Am Acad Dermatol 60:379–387

    Article  PubMed  Google Scholar 

  • Hurria A, Togawa K, Mohile SG et al (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 29:3457–3465

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Hussein MR (2010) Skin metastasis: a pathologist’s perspective. J Cutan Pathol 37:e1–e20

    Article  PubMed  Google Scholar 

  • Kahler KC, Egberts F, Gutzmer R (2013) Palliative treatment of skin metastases in dermato-oncology. Journal Der Deutschen Dermatologischen Gesellschaft 11:1041–1047

    PubMed  Google Scholar 

  • Kippenhan T, Hirche C, Lehnhardt M et al (2013) Palliative plastic surgery in multidisciplinary therapeutic concepts. Zentralbl Chir. doi:10.1055/s-0032-1328184

    PubMed  Google Scholar 

  • Larkin JO, Collins CG, Aarons S et al (2007) Electrochemotherapy: aspects of preclinical development and early clinical experience. Ann Surg 245:469–479

    Article  PubMed Central  PubMed  Google Scholar 

  • Levy Faber D, Fadel E, Kolb F et al (2013) Outcome of full-thickness chest wall resection for isolated breast cancer recurrence. Eur J Cardiothorac Surg 44:637–642

    Article  PubMed  Google Scholar 

  • Lookingbill DP, Spangler N, Helm KF (1993) Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients. J Am Acad Dermatol 29:228–236

    Article  CAS  PubMed  Google Scholar 

  • Mali B, Jarm T, Snoj M et al (2013) Antitumor effectiveness of electrochemotherapy: a systematic review and meta-analysis. Eur J Surg Oncol 39:4–16

    Article  CAS  PubMed  Google Scholar 

  • Marty M, Sersa G, Garbay JR 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 4:3–13

    Article  CAS  Google Scholar 

  • Matthiessen LW, Johannesen HH, Hendel HW et al (2012) Electrochemotherapy for large cutaneous recurrence of breast cancer: a phase II clinical trial. Acta Oncol 51:713–721

    Article  PubMed  Google Scholar 

  • Mir LM, Orlowski S, Belehradek J et al (1991) Electrochemotherapy potentiation of antitumour effect of bleomycin by local electric pulses. Eur J Cancer 27:68–72

    Article  CAS  PubMed  Google Scholar 

  • Mir LM, Sersa G, Collins C 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 by means of invasive or non-invasive electrodes. EJC Suppl 4:14–25

  • Neumann E, Kakorin S, Toensing K (2000) Principles of membrane electroporation and transport of macromolecules. Methods Mol Med 37:1–35

    CAS  PubMed  Google Scholar 

  • Sersa G, Cufer T, Paulin SM et al (2012) Electrochemotherapy of chest wall breast cancer recurrence. Cancer Treat Rev 38:379–386

    Article  PubMed  Google Scholar 

  • Swain SM, Whaley FS, Ewer MS (2003) Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer 97:2869–2879

    Article  CAS  PubMed  Google Scholar 

  • Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European organization for research and treatment of cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216

    Article  CAS  PubMed  Google Scholar 

  • Van Der Zee J, De Bruijne M, Mens JW et al (2010) Reirradiation combined with hyperthermia in breast cancer recurrences: overview of experience in Erasmus MC. Int J Hyperth 26:638–648

    Article  Google Scholar 

  • Wahl AO, Rademaker A, Kiel KD et al (2008) Multi-institutional review of repeat irradiation of chest wall and breast for recurrent breast cancer. Int J Radiat Oncol Biol Phys 70:477–484

    Article  PubMed  Google Scholar 

  • Whelan MC, Larkin JO, Collins CG et al (2006) Effective treatment of an extensive recurrent breast cancer which was refractory to multimodal therapy with multiple applications of electrochemotherapy. EJC Suppl 4:32–34

    Article  Google Scholar 

  • Willner J, Kiricuta IC, Kolbl O (1997) Locoregional recurrence of breast cancer following mastectomy: always a fatal event? Results of univariate and multivariate analysis. Int J Radiat Oncol Biol Phys 37:853–863

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  • Yancik R, Wesley MN, Ries LAG et al (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 285:885–892

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Romina Spina for data collection. Our special thanks to the nursing staff of CEMURNI (CEntro MUltidisciplinare Radiazioni Non Ionizzanti) and Radiotherapy Unit at Veneto Institute of Oncology, Padova.

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Via Gattamelata, 64, 35128, Padua, Italy

    Luca G. Campana & Carlo R. Rossi

  2. Radiotherapy Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy

    Sara Galuppo

  3. Medical Oncology School, University of Padova, Padua, Italy

    Sara Valpione

  4. Medical Oncology 1 Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy

    Antonella Brunello

  5. Medical Oncology 2 Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy

    Cristina Ghiotto

  6. Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy

    Alessia Ongaro

Authors
  1. Luca G. Campana
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  2. Sara Galuppo
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  3. Sara Valpione
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  4. Antonella Brunello
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  5. Cristina Ghiotto
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  6. Alessia Ongaro
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  7. Carlo R. Rossi
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Corresponding author

Correspondence to Luca G. Campana.

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Campana, L.G., Galuppo, S., Valpione, S. et al. Bleomycin electrochemotherapy in elderly metastatic breast cancer patients: clinical outcome and management considerations. J Cancer Res Clin Oncol 140, 1557–1565 (2014). https://doi.org/10.1007/s00432-014-1691-6

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  • DOI: https://doi.org/10.1007/s00432-014-1691-6

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