Pulsed electric field (PEF) ablation utilizes nonthermal energy to disrupt cell membrane integrity and cellular homeostasis. Preclinical data suggests that the absence of thermal damage allows for the release of intact tumor-associated antigens, inciting a widespread immune response. This therapy could thus have the potential to both treat target tumors directly and treat distant lesions through abscopal effects. The purpose of this study is to describe our early experience with pulsed electric field ablation, specifically safety and short-term outcomes. A retrospective observational study was performed on patients that underwent pulsed electric field ablation utilizing the Aliya System (Galvanize Therapeutics, Redwood City, CA) at one institution. Patient demographics, procedural details, complications, concurrent immunotherapies, and outcomes were assessed. A total of 15 PEF procedures were performed in 12 patients. Tumors treated included lung, liver, melanoma, and nodal metastases with mean target tumor size of 4.1 cm. At time of ablation, 9 patients had additional sites of metastatic disease and 6 patients were on concurrent systemic therapy. A mean of 5.1 applicator activations were used per target, with concurrent biopsies performed in 80% of cases. In this interim analysis, follow-up imaging was available in 11/12 patients, with a mean follow-up of 3.6 months, limiting evaluation of local effects. Untreated distant metastases decreased in 1/12 patients, increased in 5/12, and were stable in 2/12. Six patients underwent subsequent systemic therapy following ablation, one patient underwent subsequent radiation therapy, and two underwent subsequent ablations. Pulsed electric field ablation is a safe technique to treat metastatic disease in the palliative setting, with low rates of complications. Larger trials and long-term follow-up are needed to further evaluate potential abscopal effects.
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Cramer et al. (2024) studied this question.