Download 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: 100s
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