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Review

Irreversible Electroporation (IRE) in Locally Advanced Pancreatic Cancer: A Review of Current Clinical Outcomes, Mechanism of Action and Opportunities for Synergistic Therapy

1
Centre of Surgical Innovation, Organ Regeneration and Transplantation, University College London (UCL), London NW3 2QG, UK
2
Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK
3
Royal Free NHS Foundation Trust, London NW3 2QG, UK
4
Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London WC1E 6BT, UK
5
Newcastle Upon Tyne NHS Foundation Trust, Newcastle-Upon-Tyne NE7 7DN, UK
*
Author to whom correspondence should be addressed.
Academic Editor: Maria Del Pilar Acedo Nunez
J. Clin. Med. 2021, 10(8), 1609; https://doi.org/10.3390/jcm10081609
Received: 20 February 2021 / Revised: 4 April 2021 / Accepted: 7 April 2021 / Published: 10 April 2021
(This article belongs to the Special Issue Pancreatic Cancer: Challenges and Breakthroughs)
Locally advanced pancreatic cancer (LAPC) accounts for 30% of patients with pancreatic cancer. Irreversible electroporation (IRE) is a novel cancer treatment that may improve survival and quality of life in LAPC. This narrative review will provide a perspective on the clinical experience of pancreas IRE therapy, explore the evidence for the mode of action, assess treatment complications, and propose strategies for augmenting IRE response. A systematic search was performed using PubMed regarding the clinical use and safety profile of IRE on pancreatic cancer, post-IRE sequential histological changes, associated immune response, and synergistic therapies. Animal data demonstrate that IRE induces both apoptosis and necrosis followed by fibrosis. Major complications may result from IRE; procedure related mortality is up to 2%, with an average morbidity as high as 36%. Nevertheless, prospective and retrospective studies suggest that IRE treatment may increase median overall survival of LAPC to as much as 30 months and provide preliminary data justifying the well-designed trials currently underway, comparing IRE to the standard of care treatment. The mechanism of action of IRE remains unknown, and there is a lack of data on treatment variables and efficiency in humans. There is emerging data suggesting that IRE can be augmented with synergistic therapies such as immunotherapy. View Full-Text
Keywords: irreversible electroporation; locally advanced pancreatic cancer; immunotherapy irreversible electroporation; locally advanced pancreatic cancer; immunotherapy
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MDPI and ACS Style

Rai, Z.L.; Feakins, R.; Pallett, L.J.; Manas, D.; Davidson, B.R. Irreversible Electroporation (IRE) in Locally Advanced Pancreatic Cancer: A Review of Current Clinical Outcomes, Mechanism of Action and Opportunities for Synergistic Therapy. J. Clin. Med. 2021, 10, 1609. https://doi.org/10.3390/jcm10081609

AMA Style

Rai ZL, Feakins R, Pallett LJ, Manas D, Davidson BR. Irreversible Electroporation (IRE) in Locally Advanced Pancreatic Cancer: A Review of Current Clinical Outcomes, Mechanism of Action and Opportunities for Synergistic Therapy. Journal of Clinical Medicine. 2021; 10(8):1609. https://doi.org/10.3390/jcm10081609

Chicago/Turabian Style

Rai, Zainab L., Roger Feakins, Laura J. Pallett, Derek Manas, and Brian R. Davidson 2021. "Irreversible Electroporation (IRE) in Locally Advanced Pancreatic Cancer: A Review of Current Clinical Outcomes, Mechanism of Action and Opportunities for Synergistic Therapy" Journal of Clinical Medicine 10, no. 8: 1609. https://doi.org/10.3390/jcm10081609

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