Irreversible Electroporation: Expanding the Armamentarium against Pancreatic Cancer

Abstract

Locally advanced pancreatic cancer is often refractory to conventional therapy, thus warranting new approaches. Irreversible electroporation is an ablative modality that has the potential to deliver targeted anticancer treatment with minimal damage to surrounding structures. Indications for irreversible electroporation in pancreatic cancer patients include palliation for metastatic disease, downstaging for surgery in locally advanced disease, and treatment of local recurrence following operative resection. Benefits of the modality in pancreatic cancer include a minimally invasive approach, precise delivery that minimizes nontarget ablation, and upregulation of anticancer immune response. Early studies have demonstrated an acceptable safety profile for irreversible electroporation; however, more data are needed to define the role of IRE in the treatment algorithm of pancreatic cancer.

Keywords

pancreatic cancer - electroporation - chemotherapy

• References

• 1 Ducreux M, Cuhna AS, Caramella C. , et al; ESMO Guidelines Committee. Cancer of the pancreas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 (Suppl. 05) v56-v68
• 2 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68 (01) 7-30
• 3 Yeo TP, Lowenfels AB. Demographics and epidemiology of pancreatic cancer. Cancer J 2012; 18 (06) 477-484
• 4 Cancer facts & figures 2018 . Available at: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2018.html . Accessed May 10, 2019
• 5 Suker M, Beumer BR, Sadot E. , et al. FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis. Lancet Oncol 2016; 17 (06) 801-810
• 6 Kamisawa T, Wood LD, Itoi T, Takaori K. Pancreatic cancer. Lancet 2016; 388 (10039): 73-85
• 7 Von Hoff DD, Ervin T, Arena FP. , et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 2013; 369 (18) 1691-1703
• 8 Sadot E, Doussot A, O'Reilly EM. , et al. FOLFIRINOX induction therapy for stage 3 pancreatic adenocarcinoma. Ann Surg Oncol 2015; 22 (11) 3512-3521
• 9 Klinkenbijl JH, Jeekel J, Sahmoud T. , et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999; 230 (06) 776-782 , discussion 782–784
• 10 Neoptolemos JP, Stocken DD, Friess H. , et al; European Study Group for Pancreatic Cancer. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004; 350 (12) 1200-1210
• 11 Chauffert B, Mornex F, Bonnetain F. , et al. Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000-01 FFCD/SFRO study. Ann Oncol 2008; 19 (09) 1592-1599
• 12 Hammel P, Huguet F, van Laethem JL. , et al; LAP07 Trial Group. Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the lap07 randomized clinical trial. JAMA 2016; 315 (17) 1844-1853
• 13 Haqq J, Howells LM, Garcea G, Metcalfe MS, Steward WP, Dennison AR. Pancreatic stellate cells and pancreas cancer: current perspectives and future strategies. Eur J Cancer 2014; 50 (15) 2570-2582
• 14 McMillin DW, Negri JM, Mitsiades CS. The role of tumour-stromal interactions in modifying drug response: challenges and opportunities. Nat Rev Drug Discov 2013; 12 (03) 217-228
• 15 Alvarez R, Musteanu M, Garcia-Garcia E. , et al. Stromal disrupting effects of nab-paclitaxel in pancreatic cancer. Br J Cancer 2013; 109 (04) 926-933
• 16 Keane MG, Bramis K, Pereira SP, Fusai GK. Systematic review of novel ablative methods in locally advanced pancreatic cancer. World J Gastroenterol 2014; 20 (09) 2267-2278
• 17 Pezzilli R, Serra C, Ricci C. , et al. Radiofrequency ablation for advanced ductal pancreatic carcinoma: is this approach beneficial for our patients? A systematic review. Pancreas 2011; 40 (01) 163-165
• 18 Girelli R, Frigerio I, Giardino A. , et al. Results of 100 pancreatic radiofrequency ablations in the context of a multimodal strategy for stage III ductal adenocarcinoma. Langenbecks Arch Surg 2013; 398 (01) 63-69
• 19 Carrafiello G, Ierardi AM, Fontana F. , et al. Microwave ablation of pancreatic head cancer: safety and efficacy. J Vasc Interv Radiol 2013; 24 (10) 1513-1520
• 20 Niu L, He L, Zhou L. , et al. Percutaneous ultrasonography and computed tomography guided pancreatic cryoablation: feasibility and safety assessment. Cryobiology 2012; 65 (03) 301-307
• 21 Xu KC, Niu LZ, Hu YZ. , et al. A pilot study on combination of cryosurgery and (125) iodine seed implantation for treatment of locally advanced pancreatic cancer. World J Gastroenterol 2008; 14 (10) 1603-1611
• 22 Davalos RV, Mir IL, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng 2005; 33 (02) 223-231
• 23 Narayanan G, Bhatia S, Echenique A, Suthar R, Barbery K, Yrizarry J. Vessel patency post irreversible electroporation. Cardiovasc Intervent Radiol 2014; 37 (06) 1523-1529
• 24 Charpentier KP, Wolf F, Noble L, Winn B, Resnick M, Dupuy DE. Irreversible electroporation of the pancreas in swine: a pilot study. HPB (Oxford) 2010; 12 (05) 348-351
• 25 Narayanan G, Hosein PJ, Arora G. , et al. Percutaneous irreversible electroporation for downstaging and control of unresectable pancreatic adenocarcinoma. J Vasc Interv Radiol 2012; 23 (12) 1613-1621
• 26 Narayanan G, Hosein PJ, Beulaygue IC. , et al. Percutaneous image-guided irreversible electroporation for the treatment of unresectable, locally advanced pancreatic adenocarcinoma. J Vasc Interv Radiol 2017; 28 (03) 342-348
• 27 Leen E, Picard J, Stebbing J, Abel M, Dhillon T, Wasan H. Percutaneous irreversible electroporation with systemic treatment for locally advanced pancreatic adenocarcinoma. J Gastrointest Oncol 2018; 9 (02) 275-281
• 28 Martin II RC, Kwon D, Chalikonda S. , et al. Treatment of 200 locally advanced (stage III) pancreatic adenocarcinoma patients with irreversible electroporation: safety and efficacy. Ann Surg 2015; 262 (03) 486-494 , discussion 492–494
• 29 Scheffer HJ, Vroomen LG, de Jong MC. , et al. Ablation of locally advanced pancreatic cancer with percutaneous irreversible electroporation: results of the phase I/II PANFIRE study. Radiology 2017; 282 (02) 585-597
• 30 Narayanan G. Irreversible electroporation. Semin Intervent Radiol 2015; 32 (04) 349-355
• 31 Venkat S, Hosein PJ, Narayanan G. Percutaneous approach to irreversible electroporation of the pancreas: miami protocol. Tech Vasc Interv Radiol 2015; 18 (03) 153-158
• 32 Eisenhauer EA, Therasse P, Bogaerts J. , et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45 (02) 228-247
• 33 Wang X, Su Z, Lyu T. , et al. ¹⁸F-FDG PET biomarkers help detect early metabolic response to irreversible electroporation and predict therapeutic outcomes in a rat liver tumor model. Radiology 2018; 287 (01) 137-145
• 34 Zhang Z, Li W, Procissi D, Tyler P, Omary RA, Larson AC. Rapid dramatic alterations to the tumor microstructure in pancreatic cancer following irreversible electroporation ablation. Nanomedicine (Lond) 2014; 9 (08) 1181-1192
• 35 Li X, Xu K, Li W. , et al. Immunologic response to tumor ablation with irreversible electroporation. PLoS One 2012; 7 (11) e48749
• 36 White SB, Zhang Z, Chen J, Gogineni VR, Larson AC. Early immunologic response of irreversible electroporation versus cryoablation in a rodent model of pancreatic cancer. J Vasc Interv Radiol 2018; 29 (12) 1764-1769