Electrochemotherapy devices (Cliniporator)

IGEA's Cliniporator, developed in the European ESOPE project that published standard operating procedures in 2006, is the device behind almost all clinical electrochemotherapy. A generator delivers trains of short high-voltage pulses through plate or needle electrodes placed over or into the tumour, a few minutes after intravenous bleomycin or straight after bleomycin or cisplatin is injected into the lesion; the pulses permeabilise the membranes so a drug that normally enters cells poorly becomes hundreds of times more toxic, and they also constrict tumour vessels. Treatment takes place under local or general anaesthesia in a single session for cutaneous and subcutaneous metastases of melanoma, breast cancer, head and neck cancer and Kaposi sarcoma, and for basal and squamous skin cancers where surgery is unwanted. The Cliniporator VITAE with long needle electrodes, sometimes guided by image navigation, extends the technique to liver metastases, pancreatic cancer, bone metastases and deep head and neck recurrences, and an endoscopic version is being tested in oesophageal and colorectal tumours. Mirai Medical's ePORE is a newer platform.

The method is cheap, quick and repeatable with a high local response rate documented in the InspECT registry, spares normal tissue, and works on tumours resistant to radiotherapy; its limits are pain and muscle contraction during pulsing, treatment only of lesions the electrodes can reach and cover, lack of randomised trials against other local therapies, and limited availability outside Europe.