Plasma Cancer Therapy In Dermatology

Abstract

Main topics in cancer treatment in dermatology are melanoma (MM), basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and metastatic skin tumors. Thereof stage IV MM because of fatal outcome is uf utmost importance. Despite some substantial therapeutic progress now in this entity by immunologic treatments alternatives are warranted when disease is progressing under therapy or the tumor basically appears refractory. National guidelines currently recommend ipilumumab, vemurafenib, dabrafenib, and high-dose IL-2 as first line agents for Stage IV melanoma but no data exists to guide management of cutaneous and subcutaneous metastases which are very common. Therapeutic options include intralesional electrochemotherapy and Bacillus Calmette-Guérin, isolated limb perfusion/infusion, interferon-α, topical imiquimod, cryotherapy, radiation, interferon therapy, and intratumoral interleukin-2 injections. Recent developments include anti-programmed cell death 1 receptor agents (PD-1, nivolumab and pembrolizumab), anti-programmed death-ligand 1 agents, and oncolytic vaccines (talimogene laherparepevec), adoptive T cell therapy and dendritic cell vaccines. Regarding BCC and SCC mainly the aggressive variants are of interest for new therapies. A third entity are metastatic tumors of different origin exposing single to field canzerization. Since Cold Plasma (CAP) reacts by different and substantially more complex modes compared to classic drug chemotherapy and also modern antimetabolite and immune therapies like hitherto conventional treatment suffers from limited dosage options to avoid stronger toxicity, combined treatment with CAP offers better efficacy with less adverse effects. By this way substantial add on effects can be shown in vitro for fotemustin, dacarbacin, paclitaxel, and bleomycin. Similar potentiation can be achieved when electrochemotherapy is applied together with CAP in the presence of bleomycin (systemic) and with the squamous cell carcinoma and the actinic keratosis for the first time CAP was also shown to exert effective anticancer efficacy in humans. In metastatic tumors CAP was shown to decelerate tumor growth, defeat microbial superinfection, support pain relief and therewith increasing quality of life. Additionally for some patients CAP proved significantly better outcome together with better tolerability compared with standard treatment. The combination of conventional and physically supported chemotherapy with CAP appears highly beneficial in therapy of human cancer like melanoma and squamous cell carcinoma by enhanced tumor reduction and less drug toxicity of chemotherapeutics thus improving markedly quality of life.