Electrochemotherapy (ECT) for advanced cutaneous Angiosarcoma cases-Oct 2019

An European register-based cohort study from the International Network for Sharing Practices of Electrochemotherapy (InspECT) shows very promising results

Cutaneous angiosarcoma (cAS) is a highly aggressive malignancy that challenges the radicality of surgical treatment. Electrochemotherapy (ECT), a skin-directed treatment based on cytotoxic chemotherapy combined with local electric pulses, may be an intraoperative adjunct and a new opportunity in the therapeutic strategy. This cohort study reports the experience with ECT as an option.

• • Radical resection is arduous to achieve in advanced cutaneous angiosarcoma.
• • Electrochemotherapy may be an alternative or an adjunct to surgery.
• • Complete response was reported in 8/20 patients (40%) from the InspECT register.
• • The procedure proved to be tolerable and skin toxicity reversible.
• • Local tumour control was durable (local progression-free survival, 10.9 months).
• Treatment was effective in controlling minor or moderate tumour bleeding.

The study enrolled 20 patients with advanced cAS in the scalp/face (n=7), breast/trunk (n=10) or limbs (n=3). Target tumors (n=51) had a median size of 2.3 cm (range, 1-20). We administered 24 ECT courses using 1 to 4 cm treatment safety margin around tumours. In five patients, ECT was combined/sequenced with surgery. Median tissue current was 3 ampere (range, 1.5-10), tumour margins coverage rate was 75% (15/20 patients). The objective response rate (ORR) was 80% (complete, 40%). Grade-3 toxicity included skin ulceration (15%) and pain (10%), with no significant change of PRO scores. Bleeding control was achieved in 13/14 patients with ulcerated tumours. With a median overall survival of 12.5 months, the local progression-free survival (LPFS) was 10.9 months.

Conclusion

ECT produces sustained response rate with minimal side effects and should be considered an option for advanced cAS. Palliative benefits include patient tolerability, local haemostasis and durable local control. Definition of optimal timing, treatment safety margins and combination with surgery need further investigation.

Reference: International Journal of Surgery ,Read the full text article on #elsevier HERE