Electrochemotherapy of deep-seated tumors: State of art and perspectives as possible “epr effect enhancer” to improve cancer nanomedicine efficacy

Maria Cristina Bonferoni, Giovanna Rassu, Elisabetta Gavini, Milena Sorrenti, Laura Catenacci, Maria Luisa Torre, Sara Perteghella, Luca Ansaloni, Marcello Maestri, Paolo Giunchedi

Research output: Contribution to journalReview articlepeer-review


Surgical resection is the gold standard for the treatment of many kinds of tumor, but its success depends on the early diagnosis and the absence of metastases. However, many deep-seated tumors (liver, pancreas, for example) are often unresectable at the time of diagnosis. Chemother-apies and radiotherapies are a second line for cancer treatment. The “enhanced permeability and retention” (EPR) effect is believed to play a fundamental role in the passive uptake of drug-loaded nanocarriers, for example polymeric nanoparticles, in deep-seated tumors. However, criticisms of the EPR effect were recently raised, particularly in advanced human cancers: obstructed blood vessels and suppressed blood flow determine a heterogeneity of the EPR effect, with negative consequences on nanocarrier accumulation, retention, and intratumoral distribution. Therefore, to improve the nanomedicine uptake, there is a strong need for “EPR enhancers”. Electrochemotherapy represents an important tool for the treatment of deep-seated tumors, usually combined with the systemic (intravenous) administration of anticancer drugs, such as bleomycin or cisplatin. A possible new strategy, worthy of investigation, could be the use of this technique as an “EPR enhancer” of a target tumor, combined with the intratumoral administration of drug-loaded nanoparticles. This is a general overview of the rational basis for which EP could be envisaged as an “EPR enhancer” in nanomedicine.

Original languageEnglish
Article number4437
Issue number17
Publication statusPublished - Sep 2021


  • Bleomycin
  • Cancer nanomedicine
  • Cisplatin
  • Deep-seated tumors
  • Electrochemotherapy
  • Electroporation
  • EPR effect
  • EPR enhancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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