title: Effective treatment of intractable cutaneous metastases of breast cancer with electrochemotherapy: Ten-year audit of single centre experience.
abstract: Electrochemotherapy (ECT) is the application of electric pulses to tumour tissue to render the cell membranes permeable to usually impermeant hydrophilic anti-cancer drugs, thereby enhancing cytotoxic effects. We sought to ascertain whether ECT can be an effective palliative treatment for cutaneous metastases of breast cancer.
  
  
  
  This work reports data from the European Standard Operating Procedures for Electrochemotherapy trial (EudraCT Number: 2004-002183-18). In combination with systemic and/or intratumoural bleomycin, optimised electric pulses were delivered to locally recurrent or metastatic cutaneous breast cancer lesions. Follow-up continued until December 2014.
  
  
  
  Between February 2004 and December 2014, twenty-four patients were treated. All patients had received prior multimodal therapy. In total, the patient cohort had, or developed, 242 lesions. Two hundred and 36 lesions were treated, with 34 lost to follow-up. An objective response was seen in 161 of 202 lesions (79.7%), with a complete response observed in 130 (64.3%). Thirty-nine lesions (19.3%) did not respond, while 2 (1%) progressed following ECT. 17 (73.9%) patients received two or fewer treatments. A minimum of a partial response was seen in at least 50% of treated lesions in 18 of the 24 (75%) patients. Smaller lesions were more likely to have an objective response (Chi-square test for trend, p < 0.001).
  
  
  
  Electrochemotherapy is an effective treatment for cutaneous breast cancer lesions that have proven refractory to standard therapies. As smaller lesions were found to be more responsive, we suggest that ECT should be considered as an early treatment modality, within multimodal treatment strategies.
authors.affiliation: Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, Biosciences Institute, University College Cork, Cork, Ireland.
authors.forename: Mike G
authors.initials: MG
authors.lastname: Bourke
authors.affiliation: Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, Biosciences Institute, University College Cork, Cork, Ireland.
authors.forename: Slav P
authors.initials: SP
authors.lastname: Salwa
authors.affiliation: Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, Biosciences Institute, University College Cork, Cork, Ireland.
authors.forename: Mira
authors.initials: M
authors.lastname: Sadadcharam
authors.affiliation: Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, Biosciences Institute, University College Cork, Cork, Ireland.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Whelan
authors.affiliation: Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, Biosciences Institute, University College Cork, Cork, Ireland.
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Forde
authors.affiliation: Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, Biosciences Institute, University College Cork, Cork, Ireland.
authors.forename: John O
authors.initials: JO
authors.lastname: Larkin
authors.affiliation: Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, Biosciences Institute, University College Cork, Cork, Ireland.
authors.forename: Chris G
authors.initials: CG
authors.lastname: Collins
authors.affiliation: Department of Oncology, Cork University Hospital and Mercy University Hospital, Cork, Ireland.
authors.forename: Seamus
authors.initials: S
authors.lastname: O'Reilly
authors.affiliation: Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, Biosciences Institute, University College Cork, Cork, Ireland.
authors.forename: Gerald C
authors.initials: GC
authors.lastname: O'Sullivan
authors.affiliation: Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, Biosciences Institute, University College Cork, Cork, Ireland. j.clover@ucc.ie.|Department of Plastic Surgery, Cork University Hospital and South Infirmary Victoria University Hospital, Cork, Ireland. j.clover@ucc.ie.
authors.forename: A James
authors.initials: AJ
authors.lastname: Clover
authors.affiliation: Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, Biosciences Institute, University College Cork, Cork, Ireland.
authors.forename: Declan M
authors.initials: DM
authors.lastname: Soden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D001761:Bleomycin
keywords: Bleomycin; Breast cancer; Cutaneous metastases; Electrochemotherapy; Locoregional recurrence