Electrochemotherapy for cutaneous, subcutaneous and mucosal tumors

Mainly by the location and extent of the lesion. It is ideal for cutaneous or subcutaneous lesions with pain, bleeding or local progression, and for primary tumors where surgery would carry high morbidity or other therapies have failed. Cardiac function, comorbidities and concurrent systemic treatments are assessed; the treatment is usually very well tolerated.

Electroporation is a physical phenomenon that permeabilizes cells regardless of histology. Bleomycin crosses the cell membrane poorly and does not enter cells significantly unless they are exposed to the electric field. It therefore concentrates in cells of the treated area and not in the rest of the body, so no relevant systemic side effects occur at the dose used. Once inside the cell, bleomycin moves to the nucleus and cleaves DNA, killing any cell that attempts to divide.

According to ESOPE and global clinical series, the objective response rate ranges from 60% to 100%, depending on histology, tumor size and the patient's immune status. Basal cell and squamous cell carcinomas usually respond in 80 to 90% of cases. Sarcomas or melanomas may respond less, depending on the patient's general condition.

It depends on the size, location and depth of the lesion. In most cases the procedure is done under sedation (neuroleptanalgesia), similar to a colonoscopy. If the lesion requires it, general anesthesia can be used; for small lesions in cooperative patients, local or regional anesthesia. The anesthesiologist decides the right approach for each patient.

It is done in an operating room but on an outpatient basis: the patient goes home within two hours and does not need admission.

Mild transient pain, erythema, edema and superficial crusts. Major adverse events are uncommon and adjacent healthy tissue is not compromised, so recovery is usually very good.

Patients with pacemakers can be treated, with caution for lesions over or very close to the device pocket.

For patients on anticoagulant or antiplatelet therapy, stopping medication about three days before is recommended to minimize bleeding risk.

Immunosuppressed patients can be treated; although response rates may be lower or more sessions may be needed, repeated treatment improves response and promotes training of innate immunity.

Yes. It can be used as neoadjuvant, adjuvant or concurrent treatment. It is synergistic with immunotherapy because it reduces local tumor burden, promotes antigen presentation and alters the suppressive tumor microenvironment. Repeated sessions may train both adaptive and innate immune responses, even in immunosuppressed patients.

An operating room, a stable power supply and trained staff. The GEM team supports the launch.

It is added as a low-complexity outpatient procedure, without admission, compatible with regular surgical scheduling.

The treating physician must be trained in the technique and in basic operating room practice (both are covered in the electrochemotherapy course), and an anesthesiologist must be present.

GEM supports the whole process: clinical presentation, reports, medico-legal arguments and appeals when needed.

No. Electrochemotherapy is highly cost-effective: it helps reduce costs in complex patients and sets the institution apart from centers that do not offer the therapy.