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      Electroporación irreversible: presente y futuro en el tratamiento del carcinoma hepatocelular Translated title: Irreversible electroporation: present and future in the treatment of hepatocellular carcinoma

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          Resumen

          Entre los tratamientos actuales para el carcinoma hepatocelular se encuentra un grupo de técnicas de ablación mínimamente invasivas con gran aceptación clínica por su mayor eficacia y seguridad respecto a las terapias tradicionales, bajo coste económico y aplicación ambulatoria.

          La electroporación irreversible es una técnica de ablación no térmica que crea nanoporos en la membrana celular mediante administración de campos eléctricos, induciendo la muerte de las células tumorales. Aunque la electroporación irreversible presenta resultados prometedores en numerosos ensayos clínicos, su control a largo plazo del crecimiento y de las recidivas tumorales es inferior al de la radiofrecuencia. La combinación de electroporación irreversible con agentes inmunológicos podría aumentar su eficacia tanto en el tratamiento de lesiones focales como de metástasis. Esta revisión realiza una actualización sobre la electroporación irreversible: procedimiento, mecanismo de acción, aplicación como tratamiento del carcinoma hepatocelular y alternativas de mejora que están aflorando en los últimos años.

          Abstract

          Currently, among the possible treatments for hepatocellular carcinoma there is group of minimally invasive ablation techniques with wide clinical acceptance due to their greater efficacy and safety in comparison to traditional therapies, low cost, and no need of being admitted to hospital (outpatient treatment program).

          Irreversible electroporation is a non-thermal abla-tion technique in which electrical fields are used to create nanopores in the cell membrane that induce tumor cell death. Irreversible electroporation has shown promising results in numerous clinical trials; however, its control on long-term tumor growth and recurrence is inferior in comparison to that of radiofrequency. Combining irreversible electroporation with immunological agents may increase its efficacy in the treatment of focal lesions and metastases. In this work, we present an update on IRE including procedure, mechanism of action, application as a treatment for HCC, and the improvements that have been made in the past few years.

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          Most cited references70

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          EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

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            Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma

            The combination of atezolizumab and bevacizumab showed encouraging antitumor activity and safety in a phase 1b trial involving patients with unresectable hepatocellular carcinoma.
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              Sorafenib in advanced hepatocellular carcinoma.

              No effective systemic therapy exists for patients with advanced hepatocellular carcinoma. A preliminary study suggested that sorafenib, an oral multikinase inhibitor of the vascular endothelial growth factor receptor, the platelet-derived growth factor receptor, and Raf may be effective in hepatocellular carcinoma. In this multicenter, phase 3, double-blind, placebo-controlled trial, we randomly assigned 602 patients with advanced hepatocellular carcinoma who had not received previous systemic treatment to receive either sorafenib (at a dose of 400 mg twice daily) or placebo. Primary outcomes were overall survival and the time to symptomatic progression. Secondary outcomes included the time to radiologic progression and safety. At the second planned interim analysis, 321 deaths had occurred, and the study was stopped. Median overall survival was 10.7 months in the sorafenib group and 7.9 months in the placebo group (hazard ratio in the sorafenib group, 0.69; 95% confidence interval, 0.55 to 0.87; P<0.001). There was no significant difference between the two groups in the median time to symptomatic progression (4.1 months vs. 4.9 months, respectively, P=0.77). The median time to radiologic progression was 5.5 months in the sorafenib group and 2.8 months in the placebo group (P<0.001). Seven patients in the sorafenib group (2%) and two patients in the placebo group (1%) had a partial response; no patients had a complete response. Diarrhea, weight loss, hand-foot skin reaction, and hypophosphatemia were more frequent in the sorafenib group. In patients with advanced hepatocellular carcinoma, median survival and the time to radiologic progression were nearly 3 months longer for patients treated with sorafenib than for those given placebo. (ClinicalTrials.gov number, NCT00105443.) 2008 Massachusetts Medical Society
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                Author and article information

                Contributors
                Role: InvestigaciónRole: MetodologíaRole: SoftwareRole: ValidaciónRole: VisualizaciónRole: Redacción - borrador originalRole: Redacción - revisión y edición
                Role: ConceptualizaciónRole: Curación de datosRole: Análisis formalRole: Adquisición de fondosRole: InvestigaciónRole: MetodologíaRole: Administración del proyectoRole: RecursosRole: SoftwareRole: SupervisiónRole: Redacción - revisión y edición
                Role: ConceptualizaciónRole: Curación de datosRole: Análisis formalRole: Adquisición de fondosRole: InvestigaciónRole: MetodologíaRole: Administración del proyectoRole: RecursosRole: SupervisiónRole: ValidaciónRole: VisualizaciónRole: Redacción - borrador originalRole: Redacción - revisión y edición
                Journal
                An Sist Sanit Navar
                An Sist Sanit Navar
                assn
                Anales del Sistema Sanitario de Navarra
                Gobierno de Navarra. Departamento de Salud
                1137-6627
                2340-3527
                21 November 2022
                Sep-Dec 2022
                : 45
                : 3
                : e1019
                Affiliations
                [1 ] original Departamento de Radiología. Clínica Universidad de Navarra. Pamplona. España orgdiv1Departamento de Radiología orgnameClínica Universidad de Navarra Pamplona, España
                [2 ] original Programa de Inmunología e Inmunoterapia. Centro de Investigación Médica Aplicada. Pamplona. España orgdiv1Programa de Inmunología e Inmunoterapia orgnameCentro de Investigación Médica Aplicada Pamplona, España
                Author notes
                [Correspondencia ] Isabel Vivas. E-mail: isvivasp@ 123456unav.es

                Conflictos de intereses: Los autores declaran no tener conflictos de intereses.

                Financiación: Los autores declaran no haber recibido financiación externa para la realización de este estudio.

                Author information
                http://orcid.org/0000-0003-4960-0261
                http://orcid.org/0000-0003-1641-3881
                http://orcid.org/0000-0002-2667-0753
                Article
                10.23938/ASSN.1019
                10065056
                36413004
                1ade937a-d1f0-42d8-b91b-090b5959a223

                Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons

                History
                : 03 November 2021
                : 26 January 2022
                : 17 August 2022
                Page count
                Figures: 0, Tables: 1, Equations: 0, References: 65, Pages: 0
                Categories
                Revisión

                carcinoma hepatocelular,electroporación,agentes inmunológicos,hepatocellular carcinoma,electroporation,immunologic agents

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