Electro-Chemo-Therapy (ECT) for metastatic Melanoma
Download
Report
Transcript Electro-Chemo-Therapy (ECT) for metastatic Melanoma
Update on Electro-Chemo-Therapy in Bristol
Antonio Orlando
Department of Plastic Surgery
Southmead Hospital – North Bristol Trust
SWAG Skin SSG meeting, 17th May 2016
Electroporation of the cellular membrane:
The application of electric pulses induces cells to form a transient pore in
the cell membrane
Cell membrane before
electroporation
Pores formation
Low dosage chemotherapeutic drug can enter the cell
e.g. Bleomycin / Cisplatin (non/ poorly permeable anticancer drug
possessing a high intrinsic cytotoxicity).
ELECTROCHEMOTHERAPY
TUMOR RESPONSE
The efficacy of bleomycin in the
treatment of melanoma is increased
by over 100% when associated with
electroporation
MEDICAL DEVICE AND CHEMOTHERAPEUTIC DRUG COMBINATION:
LOCALLY ENHANCED CHEMOTHERAPY
CLINIPORATOR
EPSO2, ECT, CE Mark, Class IIa
Elettric field amplitude: 1000V/cm
Electric field distribution: omogeneous
Pulse number: 8
Pulse lenght: 100s
STANDARD OPERATING PROCEDUReS
CLINIPORATOR ELECTRODES
PLATE: P-30-8B
HEXAGONAL NEEDLE:
FINGER ELECTRODE:
N–10/20/30-HG
F–05/10-LG
LINEAR NEEDLE:
N-10/20/30-HG
FINGER ELECTRODE:
Handles
F–05/10-OR
Adjustable leght exagonal electrode
Indications
ECT is an effective treatment of neoplastic lesions
located in the skin or subcutaneous tissue, both primary
and metastatic, regardless of the histological type of
the neoplasm or previous treatments.
It can be used as an adjunct to normal treatment
options or as an additional option for patients
unresponsive or unfit for normal treatment regimes
Indications
melanoma
basal cell carcinoma
squamous cell carcinoma
kaposi sarcoma
local recurrences or cutaneous metastases from breast
cancer, head and neck cancers
STANDARD OPERATING PROCEDURES: DRUG ADMINISTRATION
Intra-tumoral administration: BLM and CDDP
Volume ab2/6
V < 0.5 cm3
BLM 1000IU/ml 1ml/cm3 (> 0,1ml)
CDDP 2mg/ml
1ml (2 mg)/cm3
0.5 cm3 < V < 1 cm3
V > 1 cm3
0.5ml/cm3
0,25 ml/cm3
0.5ml (1 mg)/cm3
0,25 ml (0.5mg)/cm3
Intravenous administration: Bleomycin
Standard dose 15.000 IU/m2 in bolus;
Electric pulses delivered after 8 minutes of the drug administration to
allow optimized diffusion;
Window timing for electric pulses: 30-40 minutes.
ECT centres in Europe
4
7
12
28
3
5
Country
Centres
Italy
28
Germany
12
Austria
1
Portugal
1
Spain
3
Sweden
3
Greece
5
Great Britain
7 (6*)
Hungary
1
Poland
1
The Netherlands
1
Lithuania
1
ESOPE
4
Research
12
Total
80
* A further 6 UK Trusts have applied for new CLINIPORATOR set up
ECT in North Bristol Trust
Total of 70 ECT procedures on 52 patients
January 2012 – May 2016 (see bar chart)
Most commonly used for melanoma (pie chart), but also
successfully used for breast cancer, SCC, BCC (including
2 Gorlin’s cases), Merkel cell, angiosarcoma and T-cell
lymphoma
ECT – Southmead experience
52 patients: 30 females, 22 males
Age range: 29-98yrs
Mean age: 73.7yrs
Median age: 77.5yrs
Diagnosis
Melanoma
BCC (incl. Gorlin's)
SCC
Breast Ca
Angiosarcoma
Merkel cell
T-cell lymphoma
Annual Breakdown
25
20
15
10
5
0
2012
2013
2014
2015
2016
ECT Pathway
-
Referral to the SSMDT
Consultation with plastic surgeon
Lung function test/pre op assessment for GA
Oncology referral
Day case GA
Follow up 6/weeks
Re-treat not before 8-12 weeks
ECT +Lesional Excision
Lesional excision
% ECT cases
Yes
56%
No
44%
Thank you