Abstract
Simple SummaryElectrochemotherapy (ECT) is an emerging treatment for solid tumors and an attracting research field due to its clinical results. ECT in association with bleomycin is an effective and safe treatment option in the vulvar cancer palliative setting. With regard to cisplatin (CSP)-based ECT, considering the clear evidence on its efficacy in gynecological tumors, the possibility to improve local control with CSP-based ECT is intriguing and a well-designed randomized clinical trial should be addressed to this issue.Electrochemotherapy (ECT) is an emerging treatment for solid tumors and an attractive research field due to its clinical results. This therapy represents an alternative local treatment to the standard ones and is based on the tumor-directed delivery of non-ablative electrical pulses to maximize the action of specific cytotoxic drugs such as cisplatin (CSP) and bleomycin (BLM) and to promote cancer cell death. Nowadays, ECT is mainly recommended as palliative treatment. However, it can be applied to a wide range of superficial cancers, having an impact in preventing or delaying tumor progression and therefore in improving quality of life. In addition, during the natural history of the tumor, early ECT may improve patient outcomes. Our group has extensive clinical and research experience on ECT in vulvar tumors in the palliative setting, with 70% overall response rate. So far, in most studies, ECT was based on BLM. However, the potential of CSP in this setting seems interesting due to some theoretical advantages. The purpose of this report is to: (i) compare the efficacy of CSP and BLM-based ECT through a systematic literature review; (ii) report the results of our studies on CSP-resistant squamous cell tumors cell lines and the possibility to overcome chemoresistance using ECT; (iii) discuss the future ECT role in gynecological tumors and in particular in vulvar carcinoma.
Highlights
Vulvar carcinoma (VC) is a rare disease (5% of all gynecological neoplasms) with the highest incidence in the elderly, in recent years, the spread of human papilloma virus (HPV) infection in young women changed this trend [1]
We summarized the principles of ECT, the mechanism of action of bleomycin (BLM) and cisplatin (CSP), the most frequently drugs combined with EP, and evidence on ECT in VC
We considered only the equipment described in the European Standard Operating Procedures on Electrochemotherapy (ESOPE) procedures other types of electroporators, needles, drugs and dosages, were described in the literature [17,18,19,20,21]
Summary
Vulvar carcinoma (VC) is a rare disease (5% of all gynecological neoplasms) with the highest incidence in the elderly, in recent years, the spread of human papilloma virus (HPV) infection in young women changed this trend [1]. Squamous cell carcinoma (SCC) is the most frequent histological type (90% of cases), several rare entities such as melanoma, extra-mammary Paget’s disease, Bartholin’s gland adenocarcinoma, verrucous carcinoma, basal cell carcinoma (BCC), and sarcoma can occur [2,3,4]. Surgery is the standard treatment, frequently combined with neoadjuvant chemoradiation; alternatively, the treatment is based on exclusive chemoradiation, based on disease site and patient’s performance status [5]. VC is often multifocal and recurs in about one third of cases with 70% 5-year overall survival rate [5]. When VC recurs, the therapeutic options are limited due to the frequently advanced patient’s age leading to the frequent referral to palliative care alone. Tumor response rates are dismal and data on symptoms relief are almost completely lacking
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