Tuesday 28th April 2015
Mac Voice, the magazine for Macmillan professionals: Spring 2015
Carol Cuthbert explains how electrochemotherapy is offering hope for people with cancers affecting the skin at St. George’s Hospital in Tooting
For the last four years, I have been involved in setting up and running a treatment that is relatively new to the UK called electrochemotherapy. I believe it is a vital new treatment option and I want to raise awareness about its benefits.
What is electrochemotherapy?
Electrochemotherapy combines a low dose of a chemotherapy drug and an electrical pulse, which is applied directly to the cancer cells using an electrode.
When the electric pulse is applied, the cells form pores allowing the drug to enter and be active against the cancer. Electrochemotherapy has the advantage of preserving healthy tissue when compared to other treatment options. It can also be used to shrink large cancers, making them easier to remove surgically.
Electrochemotherapy can be used to treat:
Why do some people need electrochemotherapy?
People who are living with advanced cancers, particularly with melanoma and breast cancer, often get metastases to the skin.
For example, it is common for my metastatic melanoma patients to present with multiple cutaneous (skin-related) metastases, which are notoriously difficult to treat. These often present on the torso and the lower and upper limbs.
Systemic therapy alone can have limited efficacy in the treatment of their skin tumours and can cause significant morbidity, including infection, bleeding, odour and pain.
Many people affected tell us they associate their cutaneous metastases with the greatest effect on their quality of life.
When is electrochemotherapy suitable?
People who are suitable for treatment with electrochemotherapy are those with multiple cutaneous metastases as a result of metastatic melanoma, breast cancer, head and neck cancer or non-melanoma skin cancers.
Clinical research shows that the best response is obtained when there are less than 20 lesions, which are less than three centimetres in diameter. Often in clinical practice, people are referred when their disease is presenting at a more advanced stage and it is therefore harder to treat.
It would be great if by raising awareness of this treatment option, people could be referred sooner and we would achieve the best response rate possible.
To date, at St. George’s, we have treated 70 people using electrochemotherapy – some two or three times, thanks to the tolerability and repeatability of the treatment.
Their conditions have included melanoma and non-melanoma skin cancers; basal and squamous cell carcinomas; porocarcinoma; and metastatic breast cancer. Our longest surviving patient had treatment for metastatic melanoma of the lower leg four years ago. This person is delighted with the results, and continues to be free of recurrence.
The best aspect of this treatment is the hope that it gives people we treat, along with an improvement in their quality of life.
In especially large fungating tumours, where bleeding and odour are present, this therapy has been extremely beneficial as a palliative treatment. Having another option to explore is a comfort for many people.
Just knowing that there is another treatment is enough to give real hope.
NICE published guidance on electrochemotherapy in March 2013. The guidance says that electrochemotherapy may reduce symptoms and improve quality of life for appropriately selected patients.
Many people I care for find that, after electrochemotherapy, the resultant relief from their symptoms means they are able to then lead a fuller and richer life.
The outcome of electrochemotherapy is well-supported through a wealth of positive clinical publications.
I want to raise awareness about electrochemotherapy. As this is a fairly new technique, not all cancer specialists are aware of what the therapy process involves or how beneficial it can be.
At St. George’s we have a surgical session once a month, where electrochemotherapy has been performed. At these sessions we have provided training to other clinicians interested in this treatment.
You can find further information about electrochemotherapy, as well as clinical paper updates and instructional videos, on the IGEA UK website (igeamedical.co.uk).
In addition, I am happy to take any enquiries about the service by email.
Diagram adapted from: Sersa et al. Electrochemotherapy in treatment of tumours. European Journal of Surgical Oncology. 2008. 34: 232–240.
Adapted by permission under the Creative Commons Attribution-ShareAlike 3.0 license: creativecommons.org/licenses/by-sa/3.0.
NICE. Electrochemotherapy for metastases in the skin. NICE Guidance IPG446.
NICE. Electrochemotherapy for primary basal cell carcinoma and primary squamous cell carcinoma. NICE Guidance IPG447.
Email Carol Cuthbert, Macmillan Melanoma Cancer Nurse Specialist, St. George’s Hospital, London.