Medpulser Electroporation With Bleomycin Study to Treat Anterior Head and Neck Squamous Cell Carcinoma

Recurrent tumors in head and neck squamous cell carcinoma usually have a poor prognosis. In
patients suitable for salvage surgery of their recurrent disease, the success rate for local
control has been reported to be 40-50%. The surgical treatment of H&N SCC frequently results
in significant loss of organ function (e.g., inability to swallow, speak, etc.) and/or
permanent disfigurement. There is a compelling and unmet medical need for a local therapy
that destroys tumors while preserving function status and appearance in patients with
primary, recurrent, or metastatic H&N SCC.

Comparison: To compare function status at 4 months after treatment with bleomycin-EPT or
surgery in patients with locally recurrent or second primary SCC of the anterior oral cavity,
soft palate, or tonsil that have failed primary curative therapy and in whom surgical
resection is seen as an option for disease control.

Inclusion Criteria:

1. The presence of SCC of the anterior oral cavity, soft palate or tonsil must be
confirmed by histological examination of a tissue sample (e.g., biopsy) obtained
within 1 month of the patient receiving the study treatment.

2. Recurrent or second primary disease in patients where surgical resection is seen as an
option for disease control.

3. The length of the longest diameter of the study lesion must be < 5 cm and the
calculated treatment volume must be < 60.0 cm3 (tumor volume plus a 0.5 cm margin
around the tumor) for the study lesion [where treatment volume = 0.5 (A+1) (B+1)2 and
where A = length of the longest diameter (cm), B = the next longest diameter
perpendicular to "A" (cm)].

4. Tumor burden must be completely encompassed by surgery or bleomycin-EPT.

5. Age: 18 years or older.

6. Men and women of childbearing potential must use physician approved contraceptive
methods for 7 days following bleomycin-EPT.

7. Hematopoietic status:

- Absolute neutrophil count (ANC) > 1000/uL

- Platelets > 75,000/mm3

- Prothrombin time:international normalized ratio (PT:INR) ? 1.5 (correctable with
vitamin K injection)

8. Blood chemistry status:

- Transaminases < 3 times upper limit of normal

- Total bilirubin < 2.5 mg/dL

- Creatinine < 2.5 mg/dL

9. A written Informed Consent form must be signed prior to the patient receiving any
study procedures or treatments.

Exclusion Criteria:

1. Patients with tumors suspected of involving a 50% or greater encasement of a blood
vessel as measured by magnetic resonance imaging (MRI) or computed tomography (CT)
scan.

2. Patients with tumors having bone invasion.

3. Patients with any metallic implants in the treatment field.

4. Patients with hypersensitivity to bleomycin.

5. Patients who have received or will exceed a total lifetime dose of bleomycin greater
than 400 units.

6. Patients deemed unsuitable for general anesthesia.

7. Patients with a significant history of emphysema or pulmonary fibrosis.

8. Patients with indwelling cardiac pacemakers who cannot tolerate a period with
pacemaker turned off.

9. Patients with a history of uncontrolled cardiac arrhythmia.

10. Women who are pregnant, or are nursing. Women of childbearing potential must have a
negative beta-human chorionic gonadotropin (beta-HCG) test within 7 days of study
treatment.

11. Radiation therapy to the treatment area within 8 weeks of study treatment.

12. Chemotherapy or other cancer therapy (e.g., surgery, cryotherapy, etc.) to the
treatment area within 4 weeks of study treatment.

13. Patients participating in a clinical study for an investigational drug or device
within 4 weeks prior to the study treatment.

14. Patients previously randomized to this study.