Long-lasting response to electrochemotherapy in melanoma patients with cutaneous metastasis

BMC Cancer

Corrado Caracò³  Nicola Mozzillo³  Ugo Marone³  Ester Simeone¹  Lucia Benedetto³  Gianluca Di Monta³  Maria Luisa Di Cecilia³  Gerardo Botti²  Paolo Antonio Ascierto¹ 

[1] Unit of Medical Oncology, Istituto Nazionale per lo Studio e la cura dei tumori “Fondazione G.Pascale” IRCCS, Naples, Italy

[2] Unit of Pathology, Istituto Nazionale per lo Studio e la cura dei tumori “Fondazione G.Pascale” IRCCS, Naples, Italy

[3] Unit of Surgery “Melanoma - Soft Tissues – Head & Neck – Skin Cancers”, Istituto Nazionale per lo Studio e la cura dei tumori “Fondazione G.Pascale” IRCCS, Naples, Italy

关键词: Cutaneous metastases;    Melanoma;    Electrochemotherapy;   

Others  :  859234
DOI  :  10.1186/1471-2407-13-564

 received in 2013-06-05, accepted in 2013-11-24,  发布年份 2013

【 摘 要 】

Background

Treatment of early and multiple cutaneous unresectable recurrences is a major therapeutic problem with around 80% of patients relapsing within 5 years. For lesions refractory to elective treatments, electrochemotherapy (ECT) involving electroporation combined with antineoplastic drug treatment appears to be a new potential option. This study was undertaken to analyze the short- and long-term responses of lesions treated with ECT with intravenous injection of bleomycin in melanoma patients with in-transit disease or distant cutaneous metastases.

Methods

Between June 2007 and September 2012, 60 patients with relapsed and refractory cutaneous melanoma metastases or in-transit disease underwent 100 courses of ECT with intravenous injection of bleomycin. Response to treatment was evaluated three months after ECT. A long-lasting response was defined as no cutaneous or in-transit relapse after a minimum of six months.

Results

Three months after ECT, a complete response was observed in 29 patients (48.4%), a partial response in 23 patients (38.3%) and no change or progressive disease in 8 patients (13.3%). The objective response rate of all treated lesions was 86.6%. Thirteen patients (44.8% of complete responders) experienced a long-lasting response after one ECT session and were disease-free after a mean duration of follow-up of 27.5 months.

Conclusions

The favorable outcome obtained in the present study demonstrates that ECT is a reliable, and effective procedure that provides long-term benefit in terms of curative and palliative treatment for unresectable cutaneous lesions without adversely impacting the quality of life of patients.

【 授权许可】

   
2013 Caracò et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Leon P, Daly J, Synnestvedt M, Schultz DJ, Elder DE, Clark WH Jr: The prognostic implications of microscopic satellites in patients with clinical Stage I melanoma. Arch Surg 1991, 126:1461-1468.
• [2]Kretschmer L, Beckmann I, Thoms KM, Mitteldorf C, Bertsch HP, Neumann C: Factors predicting the risk of in-transit recurrence after sentinel lymphadenectomy in patients with cutaneous malignant melanoma. Ann Surg Oncol 2006, 13:1105-1112.
• [3]Marty M, Garbay JM, Gehl J, et al.: Electrochemotherapy an easy, highly effective and safe treatment of cutaneous and subcutaneous metastases: results of ESOPE (European Standard Operating Procedures of Electrochemotherapy) study. Eur J Cancer 2006, 4:3-13.
• [4]Pawlik TM, Ross MI, Thompson JF, Eggermont AM, Gershenwald JE: The risk of in-transit melanoma metastasis depends on tumor biology and not the surgical approach to regional lymph nodes. J Clin Oncol 2006, 23:4588-4590.
• [5]Mir LM: Based and rationale of the electrochemotherapy. Eur J Cancer 2006, 4(Suppl):38-44.
• [6]Larkin JO, Collins CG, Aarons S, et al.: Electrochemotherapy: aspects of preclinical development and early clinical experience. Ann Surg 2007, 245:469-479.
• [7]Gehl J: Electrochemotherapy : theory and methods, perspectives for drug delivery gene therapy and research. Acta Physiol Scand 2003, 177:437-447.
• [8]Sersa G, Miklavcic D, Cemazar M, Rudolf Z, Pucihar G, Snoj M: Electrochemotherapy in treatment of tumors. Eur J Surg Oncol 2007, 34:232-240.
• [9]Gehl J, Geersen PF: Efficient palliation of haemorragic malignant melanoma skin metastases by electrochemotherapy. Melanoma Res 2000, 10:585-589.
• [10]Quaglino P, Mortera C, Osella-Abate S, et al.: Electrochemotherapy with intravenous bleomycin in the local treatment of skin melanoma metastases. Ann Surg Oncol 2008, 15:2215-2222.
• [11]Sersa G, Stabuc B, Cemazar M, Miklavcic D, Rudolf Z: Electrochemotherapy with cisplatin: systemic antitumor effectiveness of cisplatin can be potentiated locally by the application of electric pulses in the treatment of malignant melanoma skin metastases. Melanoma Res 2000, 10:381-385.
• [12]Kaehler KC, Egberts F, Hauschild A: Electrochemotherapy in symptomatic melanoma skin metastases: intraindividual comparison with conventional surgery. Dermatol Surg 2010, 36:1200-1202.
• [13]Mozzillo N, Caracò C, Mori S, et al.: Use of neoadjuvantelectrochemotherapy to treat a large metastatic lesion of the cheek in a patient with melanoma. J Transl Med 2012, 10:131. BioMed Central Full Text
• [14]Moller MG, Salwa S, Soden DM, et al.: Electrochemotherapy as an adjunct or alternative to other treatments for unresectable or in-transit melanoma. Expert Rev Anticancer Ther 2009, 9:1611-1630.
• [15]Kis E, Olah J, Ocsai H, et al.: Electrochemotherapy of cutaneous metastases of melanoma. A case series study and systematic reviewe of the evidence. Dermatol Surg 2011, 37:816-824.
• [16]Colombo GL, Di Matteo S, Mir LM: Cost-effectiveness analyses of electrochemotherapy with the Cliniporatorvs other methods for the control and treatments of cutaneous and subcutaneous tumors. Therap Clin Risk Manag 2008, 4:1-8.
• [17]Campana LG, Mocellin S, Basso M, et al.: Bleomycin-based electrochemotherapy: clinical outcome from a single institution’s experience with 52 patients. Ann Surg Oncol 2009, 16:191-199.
• [18]Sanki A, Kam PC, Thompson JF, et al.: Long-term results of hyperthermic, isolated limbperfusion for melanoma: a reflection of tumor biology. Ann Surg 2007, 245:591-596.
• [19]Snoj M, Paulin-Kosir Z, Cemazar S, Sersa G: Long lasting complete response in melanoma treated by electrochemotherapy. Eur J Cancer 2006, 4(Suppl):2.