Non-melanoma skin cancer treated with electrochemotherapy: Clinical outcomes and tolerability

Background: Electrochemotherapy (ECT) combines electroporation and chemotherapy to enhance cytotoxic drug uptake in tumor cells. This study evaluates the efficacy and safety of ECT using intravenous bleomycin in patients with non-melanoma skin cancer (NMSC). Methods: Sixteen patients with histologically confirmed NMSC were treated under neuroleptoanalgesia in an outpatient setting. Intravenous bleomycin was administered at a dose of 15,000 IU/m² of body surface area. Electric pulses were delivered using the OncoPore device (BIOTEX SRL, Buenos Aires, Argentina). Each session lasted less than one hour, and all but one patient required a single treatment. Tumor response was assessed according to RECIST criteria, and adverse events were graded following CTCAE guidelines. Results: Among the 16 treated patients, 11 had squamous cell carcinoma and 5 had basal cell carcinoma. Twelve patients (75%) achieved Complete Response, three (19%) had Partial Response, and one (6%) exhibited Stable Disease (SD), yielding an Objective Response rate of 94%. Notably, one patient with recessive dystrophic epidermolysis bullosa achieved a complete response without complications. Adverse events were mild to moderate and transient. The most frequent was pain (grade 2), effectively managed with nonsteroidal anti-inflammatory drugs. Erythema (grade 1) and swelling (grade 1-2) resolved spontaneously within one week. Infection (grade 2) occurred in four patients (25%) and was successfully treated with oral antibiotics. No severe or systemic adverse events were observed. Esthetic outcomes were excellent in all cases, with preservation of surrounding healthy tissue and minimal scarring. Conclusions: ECT with intravenous bleomycin represents a safe, effective, and well-tolerated therapeutic option for patients with non-melanoma skin cancer. The high objective response rate, minimal toxicity, and favorable cosmetic results support its implementation in outpatient settings. Furthermore, its efficacy in a patient with epidermolysis bullosa suggests potential applicability in selected fragile-skin conditions. These results reinforce ECT as a valuable addition to the therapeutic armamentarium for NMSC management.