The promises - and limits - of electrochemotherapy

Electrochemotherapy (ECT) is a new cancer treatment for tumours on the skin. It has fewer side effects than traditional chemotherapy and it’s a quick procedure – so why isn’t it widely practised yet? Consultant plastic surgeon Mr Alastair MacKenzie Ross explains how ECT works and the challenges of rolling out a new treatment for cancer.

How does electrochemotherapy work?

Electrochemotherapy is a treatment which is aimed at tumours on the skin. The procedure involves sending a pulse of electricity to the target tumour to “open up” the cancer cells and make them more permeable to chemotherapy. The cells then “close” again, trapping the chemotherapy inside, which goes on to kill the cells.

What makes it different to other kinds of cancer treatment?

Electrochemotherapy uses a much lower dosage of the chemotherapy drug than conventional chemotherapy treatment, and is much more localised, only delivering the drug to the target cells.

The procedure is very short – only taking about 45 minutes, although your total hospital stay will be longer. Unlike radiotherapy, electrochemotherapy can be administered multiple times if the initial procedure does not eliminate all of the tumour.

Most of the time the side effects are quite minimal – there are small marks where the needles have pierced the skin, and you might get short-term or long-term pain from nerve cells stimulated by electricity. There is also a risk of bleeding, so this treatment might not be recommended if you need to take anticoagulants.

What is it currently used for?

Electrochemotherapy be used to treat some types of primary skin cancer, including basal cell carcinoma and squamous cell carcinoma. In particular, ECT has been used around the mouth in order to preserve tissue and function.

At the moment, it’s mainly used to treat metastases to the skin from other types of cancer, the most common being breast cancer. This is usually a palliative measure, where other types of treatment have failed, in order to reduce the pain and discomfort from the tumour.

What are the current barriers to wider use?

At the moment only a few thousand patients have been treated with electrochemotherapy and its use is limited to just a few clinics in the UK.

There are two main reasons for this. First, the treatment involves new technology which very few clinics currently possess, and it needs to be delivered by a multidisciplinary team. So there are technical and organisational barriers which we need to overcome.

Secondly, since it’s a relatively young treatment, it’s still quite experimental, and we haven’t yet collected enough data to understand the long-term outcomes of this treatment. Until we know how effective the treatment is in the long term, we can’t be sure that it offers the same improvements to lifespan as other treatment options. We do know, though, that it is a safe treatment. It is endorsed by the National Institute for Health and Care Excellence (NICE).

So on the whole, it may be some time before we see wide use of electrochemotherapy. That being said, the early results are promising – and it will be interesting to see how research on this treatment evolves in the future.