Electrochemotherapy is a new modality of treating skin metastases. I discuss here the indications and patient selection and success rates of other institutions.

1. Skin Metastases and
Electrochemotherapy:
A New Modality for Treating
Cancers
Mary Ondinee M. Igot, MD, MSCM, FPCP, FPSMO
Medical Oncologist / Neuro – Oncologist

2. Outline
• Skin Metastases
• Electrochemotherapy (ECT) for Skin Metastases
• Fundamentals
• Technical Requirements
• Chemotherapy Used
• Recent Evidence for ECT

3. Skin Metastases
• Generally, skin metastases are encountered in 0.7 –
10% of all patients with cancer.1
• Usually occur in the body region near the primary
tumor.2
• Tumors with propensity for skin metastasis3
• Melanoma 45%
• Breast Cancer 30%
• Nasal sinus 20%
• Larynx 16%
• Oral cavity 12%
• Other organs: lungs, uterus,
stomach, colon, kidney, sarcoma
1Hussein MR 2010. J Cutan Pathol.
2Bienvento 2012
3Medscape 2017

4. Skin Metastases
• Most common primary
cancer that develop skin
metastases4:
• MEN  Lung cancer
(anterior chest), head and
neck cancer
• WOMEN  Breast cancer
(anterior chest and
abdomen)
• Can mimic specific
dermatological conditions
such as a cutaneous cyst,
pyogenic granuloma,
cellulitis, and even an
infection (herpes zoster,
abscess, etc)
4Hussein MR 2010. J Cutan Pathol.

5. Skin Metastases
• Often a preterminal event that heralds a poor outcome
Hussein MR 2010. J Cutan Pathol.
Lung CA
Breast CA
Oral Cavity CA

6. Skin Metastases
• Greatly affect quality of life
• Lead to ulceration, bleeding,
and pain
• Challenge to treat!
• Supportive
• Chemotherapy, RT, surgery
• Ablation (laser, excision, etc..)

7. Dynamic Electro-enhanced Chemotherapy
(DEECT) : Fundamentals
• Electrochemotherapy is a combination of giving low
dose chemotherapy and electroporation.

8. • As electroporation is limited to the tumour-affected
area, there is MINIMAL or NO INCREASE in systemic
toxicity resulting in a good tolerability of this method.
Dynamic Electro-enhanced Chemotherapy
(DEECT) : Fundamentals

9. Dynamic Electro-enhanced Chemotherapy
(DEECT) : Technical Reqts
• Performed
using an
electrical
impulse
generator

10. Dynamic Electro-enhanced Chemotherapy
(DEECT) : Chemotherapy
• BLEOMYCIN
• enter cells
300-700 fold
with ECT
• Administered
15,000 iu IV
+/- 15,000 iu
intratumorally

11. Side Effects of Bleomycin
Most Serious:
• Pulmonary fibrosis – rare;
dose-related (in those
receiving >400 units total
dose); age-related (the older
grp)
• Anaphylaxis usually in 1st or
2nd dose

12. Head-Neck Skin Metastases
• Head-Neck cancers eventually develop ulcerating skin
lesions, resistant to both local and systemic treatments,
often painful and with strong odours due to infection.

13. Patient Selection for ECT, HNCa
Mevio N, et al. Tu mo ri, 98: 308-313, 2012

14. Response from ECT, Skin Mets from HNCa
Mevio N, et al. Tu mo ri, 98: 308-313, 2012

15. Breast Cutaneous Metastases
• Cutaneous metastases from breast cancer occur in
about 2% of patients and account for only 1% of all
metastases from this type of malignancy.
• However, breast cancer metastases to the skin represent 51%
of all of skin metastases.

16. Patient Selection for ECT
Banerjee, et al. Arch Breast Cancer 2016; Vol. 3, No. 4: 108-117

17. RR, ECT on BrCa skin lesions: Evidence from Literature
Banerjee, et al. Arch Breast Cancer 2016; Vol. 3, No. 4: 108-117

18. Response from ECT (Skin Mets Various Ca):
Evidence from Literature
MATTHIESSEN LW, et al. Acta Oncologica, 2011; 50: 621–629

19. Predictive Factors for response from ECT (Skin Mets
BrCa): Evidence from Literature
Banerjee, et al. Arch Breast Cancer 2016; Vol. 3, No. 4: 108-117

20. ELECTROCHEMOTHERAPY
Advantages
• Suitable for patients :
• with severe comorbidity
• advanced age
• already exhausted all other
treatments.
• ECT can be used to treat painful, bleeding
and weeping metastases, as well as large
lesions up to a depth of 4 cm.
• Can be done outpatient.
• Side effects are minor. Muscular
fasciculation in terms of muscle aches is
rare.
• Local tumour control is possible
• Repeatability is possible
Disadvantages
• If GA used - can have common anaesthesia
related risks.
• Use of IV bleomycin can result in pulmonary
fibrosis, particularly as this treatment is
administered to patients who have previously
received radiation therapy and who are
comorbid, older, etc.
• The electrode used during ECT is a disposable
instrument which is not particularly inexpensive.
• In the case of ECT of large lesions in particular,
the formation of large ulcers is possible due to
increased tumour decomposition.
• As the use of ECT is not curative but palliative,
it is very likely that the treatment will have to be
repeated, as the metastases become
progressive over time.

22. Thank you!