Pulsed Electric Fields in Oncology: A Snapshot of Current Clinical Practices and Research Directions from the 4th World Congress of Electroporation - PubMed (original) (raw)
Review
Pulsed Electric Fields in Oncology: A Snapshot of Current Clinical Practices and Research Directions from the 4th World Congress of Electroporation
Luca G Campana et al. Cancers (Basel). 2023.
Abstract
The 4th World Congress of Electroporation (Copenhagen, 9-13 October 2022) provided a unique opportunity to convene leading experts in pulsed electric fields (PEF). PEF-based therapies harness electric fields to produce therapeutically useful effects on cancers and represent a valuable option for a variety of patients. As such, irreversible electroporation (IRE), gene electrotransfer (GET), electrochemotherapy (ECT), calcium electroporation (Ca-EP), and tumour-treating fields (TTF) are on the rise. Still, their full therapeutic potential remains underappreciated, and the field faces fragmentation, as shown by parallel maturation and differences in the stages of development and regulatory approval worldwide. This narrative review provides a glimpse of PEF-based techniques, including key mechanisms, clinical indications, and advances in therapy; finally, it offers insights into current research directions. By highlighting a common ground, the authors aim to break silos, strengthen cross-functional collaboration, and pave the way to novel possibilities for intervention. Intriguingly, beyond their peculiar mechanism of action, PEF-based therapies share technical interconnections and multifaceted biological effects (e.g., vascular, immunological) worth exploiting in combinatorial strategies.
Keywords: cancer; electrochemotherapy; electroporation; gene electrotransfer; irreversible electroporation; quality of life; tumour-treating fields.
Conflict of interest statement
J.G. is the co-inventor of a patent regarding calcium EP and two patents regarding electrodes for EP. L.G.C. is the co-inventor of a patent regarding an electrode for EP. R.V.D. has patents in electroporation; he has equity interests and consults for start-up companies in bioelectrics.
Figures
Figure 1
Medical application of electricity in the 19th century. (a,b) Bartholow Roberts, Medical electricity: a practical treatise on the applications of electricity to medicine and surgery. Harvey Cushing/John Hay Whitney Medical Library, Philadelphia: Lea, 1882. Available at (public domain):
https://wellcomecollection.org/works/pxt787mh
(accessed on 14 February 2023). (c,d) Channing, William F. The medical application of electricity. Harvey Cushing/John Hay Whitney Medical Library, Boston: Thomas Hall, 1860. Available at (public domain):
https://wellcomecollection.org/works/szuexvz8
(accessed on 14 February 2023).
Figure 2
Pulsed electric fields in oncology. Classification and mechanism of action. * Other mechanisms of action of low-voltage, intermediate-frequency (100–500 kHz) electric fields include impairment of DNA repair, autophagy, stimulation of antitumour immunity (through increased expression of calreticulin, secretion of ATP and high mobility group protein 1 [HMGB1], activation of dendritic cells, production of proinflammatory cytokines, an increase in tumour infiltrating lymphocytes, DNA release, and metabolic changes in the tumour microenvironment), anti-migratory effects, and increased cell membrane permeability. Legend: HV-EF, high-voltage electric fields; LV-EF, low-voltage electric fields (1–3 V/cm); IRE, irreversible electroporation; ECT, electrochemotherapy; GET, gene electrotransfer; Ca-EP, calcium electroporation; TTF, tumour-treating field.
Figure 3
Current treatment indications of pulsed electric fields in oncology. Current GI tract indications include oesophageal and rectal cancer. * indicates investigational indications.
Figure 4
Electrochemotherapy modalities. In standard ECT, electric pulses are delivered using fixed-geometry needles or plate electrodes. In variable-geometry ECT (VG-ECT), long independent needle electrodes are inserted according to tumour geometry and size. In endoscopic ECT, electric pulses are administered using a dedicated luminal electrode connected to an endoscope or a single shaft capable of deploying an array of needle electrodes in confined anatomical spaces.
Figure 5
Current research directions in PEF-based therapies in oncology. The overarching and interrelated research themes include improving patient selection, enhancing treatment delivery, increasing treatment precision and safety, developing combined therapeutic strategies, clarifying best treatment timing, refining tumour response assessment, developing patient-centred outcomes, and improving the reporting of clinical studies.
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