Electrochemotherapy (ECT)

Electrochemotherapy (ECT) combines a chemotherapy drug — most often bleomycin — with short, high-voltage electric pulses applied directly to the tumor; the pulses briefly open the cell membranes so far more of the drug enters the cancer cells. ESMO guidelines list it as an option to consider for unresectable in-transit metastases of melanoma (deposits spreading within the skin): it can control lesions locally and relieve symptoms, but it has not been shown to prolong overall survival. Treatment is local and generally well tolerated, with severe side effects reported in about 5% of patients in the largest registry analysis.

How it works

The drug is given into a vein or injected directly into the lesion. A few minutes later, electrodes placed on or into the tumor deliver a series of brief electric pulses. The pulses cause electroporation — they transiently permeabilize the tumor cell membranes, which normally let very little bleomycin through, so the drug's concentration inside the cells and its cell-killing effect increase sharply. The procedure is performed under local or general anesthesia, mostly for melanoma and other tumors located in the skin or just beneath it. In published studies of locally advanced melanoma, overall response rates ranged from 63% to 100% and complete responses from 24% to 86%, with lesions smaller than 3 cm responding best; side effects are mainly local and short-lived — pain, redness, or ulceration at the treated site. In the ESMO melanoma guideline, electrochemotherapy carries a low evidence grade [IV, C] and is described as having no impact on overall survival; its combination with immunotherapy is being investigated in clinical studies.

Used in

Malignant Melanoma C43

A local treatment used for cutaneous and in-transit melanoma metastases, included in the ESMO clinical practice guideline for cutaneous melanoma [1]. An electric pulse increases uptake of bleomycin or cisplatin into tumour cells, so the drug acts within the skin lesion with little burden on the whole body; a systematic review reports objective response rates of about 63-100% in treated lesions [2]. The aim is local control of skin lesions, not cure of disseminated disease [1].

Electrochemotherapy (ECT)

How it works

Used in

Sources