Impact of electrochemotherapy in metastatic cutaneous melanoma: a contemporary systematic review and meta-analysis. (4th May 2022)

• Record Type: Journal Article
• Authors: Petrelli, Fausto; Ghidini, Antonio; Simioni, Andrea; Campana, Luca Giovanni
• Is Part Of: Acta oncologica. Volume 61:Number 5(2022)
• Page Start: 533
• Page End: 544
• Publication Date: 2022-05-04
• Subjects: Melanoma -- locoregional -- in-transit -- skin metastases -- electrochemotherapy; Oncology -- Periodicals; Cancer -- Treatment -- Periodicals; 616.992
• DOI: 10.1080/0284186X.2021.2006776
• Languages: English
• ISSNs: 0284-186X

Abstract

Abstract: Background: Electrochemotherapy (ECT) harnesses electric pulses to enhance cytotoxic drug delivery into tumors and has entered the armamentarium to treat superficially metastatic melanoma. We performed a systematic review and meta-analysis to assess treatment patterns and patient outcomes. Methods: PubMed, Medline, Embase, and the Cochrane Library databases were queried for publication from inception to September 2020. Primary outcome measures were overall and complete response rate (ORR and CRR); secondary outcomes included local control rate (LCR) and overall survival (OS). Results: Twenty-seven studies met the selection criteria for a total of 1161 individuals (mean age 71 years) and 5308 tumors (weighted mean size 14 mm). The majority of patients ( n = 1124) underwent bleomycin-ECT. Aggregate ORR was 77.6% (95% confidence interval [CI] 71.0 − 83.2%) and CRR 48% (95% CI 42 − 54%), with no significant difference between the route of bleomycin administration (ORR, 69.2 vs. 81.9% following intravenous or intratumoral bleomycin, p = .37) and tumor size ( p = .69). When reported ( n = 8 studies), 1- and 2-year LCR ranged from 54 to 89% and 72 to 74%, respectively, and 1-year OS ( n = 3 studies) from 67 to 89%. Conclusions: ECT with either intratumoral or intravenous bleomycin confers a high therapeutic response in cutaneous metastatic melanoma. Moderate evidence supports its low toxicity and durability of local control. Highlights: Electrochemotherapy (ECT) is associated with a 77% overall response rate (ORR). Intravenous and intratumoral bleomycin are equally effective. There are no relevant toxicity concerns. One-year local tumor control rate ranges from 54 to 89%. Current literature has significant variation in reporting.