Impact of electrochemotherapy in metastatic cutaneous melanoma: a contemporary systematic review and meta-analysis

Acta Oncol. 2022 May;61(5):533-544. doi: 10.1080/0284186X.2021.2006776. Epub 2021 Dec 10.


Background: Electrochemotherapy (ECT) harnesses electric pulses to enhance cytotoxic drug delivery into tumors and has entered the armamentarium to treat superficially metastatic melanoma. We performed a systematic review and meta-analysis to assess treatment patterns and patient outcomes.

Methods: PubMed, Medline, Embase, and the Cochrane Library databases were queried for publication from inception to September 2020. Primary outcome measures were overall and complete response rate (ORR and CRR); secondary outcomes included local control rate (LCR) and overall survival (OS).

Results: Twenty-seven studies met the selection criteria for a total of 1161 individuals (mean age 71 years) and 5308 tumors (weighted mean size 14 mm). The majority of patients (n = 1124) underwent bleomycin-ECT. Aggregate ORR was 77.6% (95% confidence interval [CI] 71.0 - 83.2%) and CRR 48% (95% CI 42 - 54%), with no significant difference between the route of bleomycin administration (ORR, 69.2 vs. 81.9% following intravenous or intratumoral bleomycin, p = .37) and tumor size (p = .69). When reported (n = 8 studies), 1- and 2-year LCR ranged from 54 to 89% and 72 to 74%, respectively, and 1-year OS (n = 3 studies) from 67 to 89%.

Conclusions: ECT with either intratumoral or intravenous bleomycin confers a high therapeutic response in cutaneous metastatic melanoma. Moderate evidence supports its low toxicity and durability of local control.HighlightsElectrochemotherapy (ECT) is associated with a 77% overall response rate (ORR).Intravenous and intratumoral bleomycin are equally effective.There are no relevant toxicity concerns.One-year local tumor control rate ranges from 54 to 89%.Current literature has significant variation in reporting.

Keywords: Melanoma; electrochemotherapy; in-transit; locoregional; skin metastases.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aged
  • Antibiotics, Antineoplastic / therapeutic use
  • Bleomycin / therapeutic use
  • Electrochemotherapy*
  • Humans
  • Melanoma* / pathology
  • Neoplasms, Second Primary* / drug therapy
  • Skin Neoplasms* / pathology
  • Treatment Outcome


  • Antibiotics, Antineoplastic
  • Bleomycin

Supplementary concepts

  • Melanoma, Cutaneous Malignant