Electrochemotherapy in the treatment of metastatic malignant melanoma: a prospective cohort study by InspECT

TY - JOUR

T1 - Electrochemotherapy in the treatment of metastatic malignant melanoma

T2 - a prospective cohort study by InspECT

AU - Kunte, C

AU - Letulé, V

AU - Gehl, J

AU - Dahlstroem, K

AU - Curatolo, P

AU - Rotunno, R

AU - Muir, T

AU - Occhini, A

AU - Bertino, G

AU - Powell, B

AU - Saxinger, W

AU - Lechner, G

AU - Liew, S-H

AU - Pritchard-Jones, R

AU - Rutkowski, P

AU - Zdzienicki, M

AU - Mowatt, D

AU - Sykes, A J

AU - Orlando, A

AU - Mitsala, G

AU - Rossi, C R

AU - Campana, L

AU - Brizio, M

AU - de Terlizzi, F

AU - Quaglino, P

AU - Odili, J

AU - InspECT (the International Network for Sharing Practices on Electrochemotherapy)

N1 - © 2017 British Association of Dermatologists.

PY - 2017/6

Y1 - 2017/6

N2 - Background: (ECT) is an effective local treatment for cutaneous metastasis. Treatment involves the administration of chemotherapeutic drugs followed by delivery of electrical pulses to the tumour. Objectives: To investigate the effectiveness of ECT in cutaneous metastases of melanoma and to identify factors that affect (beneficially or adversely) the outcome. Methods: Thirteen cancer centres in the International Network for Sharing Practices on Electrochemotherapy consecutively and prospectively uploaded data to a common database. ECT consisted of intratumoral or intravenous injection of bleomycin, followed by application of electric pulses under local or general anaesthesia. Results: In total, 151 patients with metastatic melanoma were identified from the database, 114 of whom had follow-up data of 60 days or more. Eighty-four of these patients (74%) experienced an overall response (OR = complete response + partial response). Overall, 394 lesions were treated, of which 306 (78%) showed OR, with 229 showing complete response (58%). In multivariate analysis, factors positively associated with overall response were coverage of deep margins, absence of visceral metastases, presence of lymphoedema and treatment of nonirradiated areas. Factors significantly associated with complete response to ECT treatment were coverage of deep margins, previous irradiation of the treated area and tumour size (< 3 cm). One-year overall survival in this cohort of patients was 67% (95% confidence interval 57–77%), while melanoma-specific survival was 74% (95% confidence interval 64–84%). No serious adverse events were reported, and the treatment was in general very well tolerated. Conclusions: ECT is a highly effective local treatment for melanoma metastases in the skin, with no severe adverse effects noted in this study. In the presence of certain clinical factors, ECT may be considered for local tumour control as an alternative to established local treatments, or as an adjunct to systemic treatments.

AB - Background: (ECT) is an effective local treatment for cutaneous metastasis. Treatment involves the administration of chemotherapeutic drugs followed by delivery of electrical pulses to the tumour. Objectives: To investigate the effectiveness of ECT in cutaneous metastases of melanoma and to identify factors that affect (beneficially or adversely) the outcome. Methods: Thirteen cancer centres in the International Network for Sharing Practices on Electrochemotherapy consecutively and prospectively uploaded data to a common database. ECT consisted of intratumoral or intravenous injection of bleomycin, followed by application of electric pulses under local or general anaesthesia. Results: In total, 151 patients with metastatic melanoma were identified from the database, 114 of whom had follow-up data of 60 days or more. Eighty-four of these patients (74%) experienced an overall response (OR = complete response + partial response). Overall, 394 lesions were treated, of which 306 (78%) showed OR, with 229 showing complete response (58%). In multivariate analysis, factors positively associated with overall response were coverage of deep margins, absence of visceral metastases, presence of lymphoedema and treatment of nonirradiated areas. Factors significantly associated with complete response to ECT treatment were coverage of deep margins, previous irradiation of the treated area and tumour size (< 3 cm). One-year overall survival in this cohort of patients was 67% (95% confidence interval 57–77%), while melanoma-specific survival was 74% (95% confidence interval 64–84%). No serious adverse events were reported, and the treatment was in general very well tolerated. Conclusions: ECT is a highly effective local treatment for melanoma metastases in the skin, with no severe adverse effects noted in this study. In the presence of certain clinical factors, ECT may be considered for local tumour control as an alternative to established local treatments, or as an adjunct to systemic treatments.

KW - Aged

KW - Aged, 80 and over

KW - Anesthesia/methods

KW - Disease Progression

KW - Electrochemotherapy/adverse effects

KW - Electrodes

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Melanoma/drug therapy

KW - Neoplasm Metastasis

KW - Pain/etiology

KW - Pain Measurement

KW - Prospective Studies

KW - Skin Neoplasms/drug therapy

KW - Treatment Outcome

KW - Tumor Burden

U2 - 10.1111/bjd.15340

DO - 10.1111/bjd.15340

M3 - Journal article

C2 - 28118487

SN - 0007-0963

VL - 176

SP - 1475

EP - 1485

JO - British Journal of Dermatology

JF - British Journal of Dermatology

IS - 6

ER -