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Regional chemotherapy (RCT) is a local chemotherapy, that is, chemotherapy restricted to one region of the body or to one organ. Thus, medication (a cytostatic or chemotherapeutic agent) is administered into the arteries (blood vessels) that supply the tumour or the tumour region with blood. Using regional therapy, a larger amount of the administered cytostatic agent is taken up by the tumour in the tissues.

Immediately following the treatment procedures, the blood is washed out by chemofiltration and the excess medication removed.

What are the advantages of regional chemotherapy?

Since regional chemotherapy is always restricted to a single body region or organ, the overall effects upon the body as a whole are less, despite the intense regional effect, and fewer side-effects occur.

Not least, as a result of the systemic detoxification performed after each treatment using chemofiltration, in 95% of cases patients tolerate the treatment extremely well. Their quality of life is less impaired, and often, it already begins to improve quite rapidly directly after treatment. Nausea and vomiting are very rarely seen after the treatment.

What is the working principle underlying regional chemotherapy?

Their aim in using regional chemotherapy is to severely damage the tumour while keeping side effects for the patient to a minimum. Regional chemotherapy is effective in treating what are known as "solid tumours.“

However not every type of tumour responds equally well to highly concentrated chemotherapy. Some tumours require extremely high concentrations of the anti tumour medication, while others show treatment effects even at lower concentrations.

The rule of thumb is that to permanently damage a solid tumour, you need about six times the concentration that can be achieved using conventional chemotherapy. With a number of different RCT techniques, it is possible to reach concentrations of cytostatic agents that are between three to ten times (and in extreme cases up to eighty times) as high as those in conventional chemotherapy.

The goal of regional chemotherapy is to reduce the size of the tumour prior to surgery to such an extent that the ensuing surgical procedure can be kept as small as possible. In the best case, the tumour disappears completely even before surgery.

Electrochemotherapy, or reversible electroporation, uses electrical voltage to porous the membrane of tumor cells, thereby enabling the increased absorption of cytostatic drugs. In particular, the effect of relatively large chemotherapeutic drugs, such as bleomycin and cisplatin, is thereby increased many times over. Thus, a very good response can be achieved with small doses.

The procedure is gentle because it is only applied locally in the tumour region and minimises the required dose of cytostatic drugs.

In contrast to irreversible electroporation, reversible electroporation works with lotheyr electrical voltages. The electrodes are placed as needles in the tumour region. Within the voltage field of the electrodes, poration of the cell membranes occurs for a few minutes. The previously infused chemotherapeutic drugs invade into the tumor cells with an increased uptake. The cytotoxicity of large-molecule bleomycin increases up to 1000-fold, that of cisplatin up to 80-fold. After a few minutes the membrane pores close and the efflux of the cytostatic drug is minimized.

• The no touch isolation technique, which refers to the surgical removal of tumours with a minimum of manipulation in order to prevent dissemination of cancer cells during surgery.

• Additional treatment of the tumour bed for thorough prevention of later regional recurrences. For this purpose, they use regional chemotherapy adapted to the specific situation, in the form of an arterial infusion or the isolated perfusion of an organ or a segment of the body.

• Low-complication surgery has a direct impact upon quality of life, especially if the operative time/duration for major procedures can be kept to a minimum, if blood loss is avoided and the occurrence of postoperative complications eliminated or minimized.

• Reconstruction following extensive procedures for tumour removal, and avoiding mutilating operations whenever possible are likewise important elements in maintaining quality of life.

• Setting indications for surgery: especially for advanced stages of tumours, this is of major importance. Surgical treatment will be performed in a manner that is adapted to the stage of the tumour administered at the proper time, and, its extent determined in accordance with the patient’s resilience.

They offer various methods of molecular diagnosis. In order to treat and target the cancer not only locally but also molecularly, they apply a variety of tests for molecular and cellular analysis.

State-of-the-art analytical methods enable the creation of a personalised therapy plan and accurate monitoring of the therapy process using blood samples and tumour issue.

Targeted treatment of only the affected body regions and therapy decisions based on molecular diagnosis enable highly personalised therapy. In this way, the tumour is specifically and effectively damaged and healthy tissue is spared.

The health condition and immune status of each patient is different. Every tumour has a specific molecular and genetic profile and therefore responds uniquely to different therapies.

Targeted molecular diagnostics can be used to find a personalised and effective therapy combination for each patient

Some families have an inherited gene fault (mutation) that can increase the risk of developing certain types of cancer. Tests are available for some inherited faulty genes.

If you are found to have a gene fault there are things you can do to reduce your risk of developing cancer.

For example, you might be able to make certain lifestyle changes or you may have regular screening to detect cancer early.

For certain cancers, you might take medication to lower the risk of developing the cancer.

Not knowing whether you have a faulty gene can cause stress and worry. Finding out the result can hugely reduce this worry.

Advantages of Genetic Testing include:

• A sense of relief from uncertainty

• Reduce the risk of cancer by making certain lifestyle changes if you have a positive result

• In-depth knowledge about your cancer risk

• Information to help make informed medical and lifestyle decisions

• Opportunity to help educate other family members about potential risk

• Earlier detection, which increases the chance of a successful outcome

• The starting point of cancer is usually a change in one or more genes in their body.

These genetic mutations are different in every patient, in every tumour and even sometimes in each metastasis. This is exactly where modern therapies come in, trying to stop the cancer at its cause, to stop it from spreading in its individual way.

Of course the individual cause must be found for this.

The cancer is no longer identified on the basis of its localisation but on the basis of its genetic variation and its specific metabolism.

Drugs are no longer chosen because the cancer grows in the breast or pancreas, but because it has a specific genetic change.

Molecular diagnostics can be carried out on a tumour sample as well as on a blood sample and enables personalised and targeted therapy.

Genetic analysis of the tumour

With the help of state-of-the-art technologies, changes in a large number of cancer relevant genes can be detected. For more and more of these specific changes, targeted therapies are available.

Roche Foundation One CDx - Next generation tumor profiling

If it is possible to take a tumour sample by means of a small operation or needle biopsy, a couple of hundred genes are examined. Furthermore, the tumour mutation burden (TMB), as well as the microsatellite instability (MSI) is determined. After about two weeks the results are available and allow the determination of targeting drugs. An individual report with personalised tumour targeting treatment options and suitable clinical studies with new drugs is included.

Roche Foundation One Liquid Biopsy

If a tumour biopsy is not possible or the patient does not wish to have one, genetic changes can be examined on the basis of a blood sample, the so-called Liquid Biopsy.

Tumours regularly release some of their DNA into the bloodstream. This is detected and analysed in a blood sample.

Alterations in about 70 tumour relevant genes are detectable with Liquid Biopsy.

In addition, microsatellite stability (MSI/MSS) is also examined. The results are available after about three weeks and allow the determination of targeting drugs.

An individual report with personalised tumour targeting treatment options and suitable clinical studies with new drugs is included.

CARIS Whole-Exome-Sequencing (THEYS) - Enhanced Tumour Profiling

With Whole Exome Sequencing of the tumor DNA, all genes are analysed (22.000 genes) and any kind of genetic alteration is detected. RNA analysis detects gene fusions which can be the reason for tumour growth. Additionally included is the analysis of Tumour Mutational Burden (TMB) and Microsatellite Status (MSI/MSS). The immune checkpoint PD-L1 and some other cancer related important biomarkers are determined by immunohistochemical staining.

The results are available after about three weeks and allow the determination of targeting drugs. An individual report with personalised tumour targeting treatment options and suitable clinical studies with new drugs is included.

PERSONALIS Immunogenetic Profiling

With an immunogenetic profile including analysis of the MHC complexes, checkpoint expression and neoantigen determination, they offer an all-encompassing diagnosis at the genetic level. Mutation analysis on DNA level and Expression analysis of the tumour on RNA level additionally show altered cancer related metabolic mechanisms. With a high sequencing depth (1000-fold), the coverage of the complete exome and transcriptome is achieved with advanced tumor profiling, the highest level of genetic diagnostics is achieved.