Electrochemotherapy in primary and metastatic skin tumors: Phase II trial using intralesional bleomycin

Background. Surgery and/or radiotherapy are the elective therapies for most primary skin cancers. Nevertheless, some patients develop recurrences, and chemotherapy has resulted in poor complete responses, Permeabilization of the cell membrane by electric pulses allows bleomycin to enter into the cel l, increasing possibility of cytotoxicity. Methods. From November 1998 through November 1999, 15 patients with 38 skin lesions participated in a phase II prospective clinical trial, using intra lesional bleomycin plus electric pulses delivered 10 min after bleomycin in jection, which lasted 100 mu sec each at field strength of 1.300 V/cm and a frequency of 1 Hz. There were basal cell carcinomas (BCC) (nine lesions), in-transit metastasis of melanoma (MM) (two patients/13 nodules), squamous cell carcinomas (SCC) of the upper aerodigestive tract metastatic to the sk in (two patients/two nodules), and skin metastases from breast cancer (two patients/14 nodules). Mean follow-up was 8.6 months. Results. Overall objective responses were 98%, with complete responses achi eved in 49% partial responses in 49%, and no responses in 2%. No complicati ons were documented related to the treatment and tolerance was adequate. Conclusions. Electrochemotherapy (ECT) is a new cancer modality of treatmen t that is effective in a variety of skin cancers. This treatment represents an excellent alternative to standard surgery or radiotherapy, with an outp atient-based treatment applied in one to three sessions. The major impact w as obtained in BBC, but ECT is a useful palliative therapy in melanoma, bre ast cancer, or SCC. More experience and longer follow-up are required to de termine long-term results. (C) 2001 IMSS. Published by Elsevier Science Inc .