Eletroquimioterapia, uma nova terapia para pacientes com câncer cutâneo na América Latina: revisão da literatura / Electrochemotherapy, a new therapy for patients with skin cancer in Latin America: literature review

A eletroquimioterapia é uma tecnologia inovadora usada para tratar cânceres de pele e mucosa. Consiste na administração intravenosa de bleomicina seguida pela aplicação de pulsos de eletroporação no tumor em suas margens. Esses pulsos induzem a formação de poros na membrana celular, aumentando a eficácia citotóxica da bleomicina em mais de 1.000 vezes. Como a eletroporação é um fenômeno físico, diferentes tipos de tumores podem ser tratados, independentemente de sua histologia. Geralmente, apenas uma sessão de tratamento é necessária para obter resposta satisfatória. A eletroquimioterapia é uma boa opção para tumores recidivantes nos quais outras terapias não proporcionam resposta. Além disso, os tumores podem ser reduzidos com a terapia, permitindo cirurgias menos agressivas e melhorando os resultados. Muitas diretrizes de tratamento começaram a incluir o uso dessa técnica não ablativa como uma nova opção de tratamento quando outras terapias falharam ou foram rejeitadas pelo paciente. O tratamento é realizado em regime ambulatorial com altas taxas de resposta e poucos efeitos colaterais.

Electrochemotherapy is an innovative technology used to treat skin and mucosal cancers. It consists of intravenous administration of bleomycin followed by the application of electroporation pulses to the tumor at its margins. These pulses induce the formation of pores in the cell membrane, increasing the cytotoxic efficacy of bleomycin by more than 1,000- fold. As electroporation is a physical phenomenon, different types of tumors can be treated regardless of their histology. Generally, only one treatment session is needed to obtain a satisfactory response. Electrochemotherapy is a good option for recurrent tumors in which other therapies do not provide a response. Additionally, tumors can be shrunk with therapy, allowing for less aggressive surgeries and improving outcomes. Many treatment guidelines have begun to include the use of this non-ablative technique as a new treatment option when other therapies have failed or been rejected by the patient. Treatment is carried out on an outpatient basis with high response rates and few side effects.

Evaluation of the safety and feasibility of electrochemotherapy with intravenous bleomycin as local treatment of bladder cancer in dogs.

Local treatment of canine urothelial carcinoma (UC) of the bladder is a challenge. More than 90% of the cases invade the muscular layer, more than 50% develop on bladder sites with a difficult surgical approach and often requiring radical surgical procedures. This study aims to evaluate the safety and feasibility of electrochemotherapy (ECT) with intravenous bleomycin (BLM) as a local therapy for bladder UC. This prospective study included 21 dogs with spontaneous bladder UC. Regional/distant metastases and neoplastic infiltration of the serosa was considered the main exclusion criteria. We had no deaths during ECT or in the immediate postoperative period, and no suture dehiscence. Most dogs (19/21) developed mild adverse effects, whereas two dogs developed ureteral stenosis. Complete response (CR) was achieved in 62% of the cases (13/21), while partial response (PR) was achieved in 24% (5/21). The median survival and disease-free survival times were 284 and 270 days, respectively. Overall survival was significantly better in the dogs who achieved a CR. In conclusion, ECT was well-tolerated in dogs with UC, demonstrating its safety and feasibility. These data pave the way for new studies aimed at evaluating the effectiveness of ECT in canine bladder UC as a translational model for human disease.

Electrochemotherapy in treatment of canine oral malignant melanoma and factors influencing treatment outcome.

Background Oral malignant melanoma is the most common, but aggressive oral cancer in dogs with poor prognosis. Electrochemotherapy (ECT) has therapeutic potential in such tumors as effective local treatment. Therefore, the aim of this prospective clinical study was to evaluate treatment effectiveness of ECT in as first line treatment for canine oral malignant melanoma, and search for factors influencing treatment outcome. Methods Sixty-seven canines with primary oral malignant melanoma, non-candidates for first-line therapy, were enrolled. All dogs received ECT and follow-up exams for the span of two years. Results Based on RECIST criteria, the objective response rate was 100%, 89.5%, 57.7%, and 36.4%, in stage I, II, III and IV, respectively. Only patients in stage I, II and III with partial or complete response improved their quality of life. The median time to progression was 11, 7, 4 and 4 months, and median survival time after the treatment was 16.5, 9.0, 7.5 and 4.5 months, for patients in stage I, II, III and IV, respectively. Significantly better was local response in stage I and II disease (p = 0.0013), without the bone involvement (p = 0.043) Conclusions Electrochemotherapy is effective local treatment of oral canine malignant melanoma when no alternative treatment is available. Better response is expected in stage I and II patients with tumors without bone involvement.