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PHOTODYNAMIC THERAPY FOR
BREAST CANCER
Ron R. Allison, M.D.
Medical Director
21st Century Oncology
801 WH Smith Blvd.
Greenville NC USA 27834
252-329-0025
[email protected]
Why PDT for breast cancer
 PDT has wide ranging success for
various cutaneous lesions
 PDT offers excellent cosmesis
 PDT is non- carcinogenic
 PDT part of a multidisciplinary approach
Clinical applications
 Primary therapy
- PD/PDT
- post excision for margins
 Salvage Therapy
- Chest wall recurrence
- metastatic lesions (of bone)
Clinical applications
 Primary disease: No peer reviewed publications
 Salvage Therapy: Multiple publications
PDT- CHESTWALL FAILURE FROM
BREAST CANCER
ECU Experience: R. Allison, R. Cuenca, G. Downie, C. Sibata
95 % DFS in advertisements…
How about the forgotten 5%?
Chestwall Failure
 Physiologic
 Lesions are painful, bleed, become infected,
itch
 Dermal lymphatics spread everywhere
 Psychologic
 Watch tumors grow
 QOL stinks
Initial Salvage
 Surgery for XRT failure
 XRT for surgical failure
 Chemo- as chestwall failure bodes for
systemic disease
However, a significant number of pts have
continued chestwall failures despite
several salvage attempts…
 Surgery
 XRT
 Chemo
:Chestwall resections &
reconstructions
: 90% failure at surgical borders
: Maximum dose is a reality
: Rib fx, fibrosis, pneumonitis
: 3rd line agents don’t give CR on
chest wall
PDT for Chestwall
 Works on cutaneous malignancies
 Literature shows good cosmetic and tumor
response
 Does not stop other therapies
 Outpatient
 Minimal tx toxicity/discomfort
 Repeatable
Clinical PDT for Chestwall
2 Distinct Systems:
1) High drug and lower light dose (directed
at tumor)
2) Low drug and higher light dose (not as
directed at tumor as you think)
High Drug/Lower Light
High Drug
Normal
0000
000 0
Tumor
0000
000 0
000 0
Normal
0000
000 0
Lower Drug/High Light
Low Drug
Normal
0000
Tumor
0000
000 0
000 0
Normal
0000
Clinical Trials
Author
N
Drug
Light(J/cm2)
Response
Significant Morbidity
Bandermonte
4
3mg
120
75%
75%
RPCI
6
2 mg
75
75%
75%
6
1 mg
150
75%
25%
6
0.6 mg
30-240
0%
0%
Allison/Mang
9
0.8 mg
150
90%
0%
Taber
7
2 mg
100
90%
50%
ECU
14
0.8 mg
150
90%
1 pt
Chestwall PDT
 50 Women with biopsy proven chestwall
disease
 Age 43-70
 No pt. lost to follow-up
 Range 3-18 months
Initial Treatment
Mastectomy and Chemo/Hormones:
Lumpectomy + XRT + Chemo/Hormones:
1st Failure
Mastectomy:
XRT:
Chemo:
2nd Failure
XRT:
Surgery:
Chemo:
At Presentation at ECU
 44 pts on narcotic analgesics
 40 pts with itching lesions
 20 pts with open wound due to tumor
 All were progressing on chemotherapy
 45 systemic mets (asymtomatic in all)
PDT
Photosensitizer : Off label Photofrin, 0.8 mg/kg
Illumination
: 632 nm diode laser
Tx Protocol
: 0.8 mg/kg Photofrin followed 48 hrs
later by outpt illumination at 150 J/cm2
PDT Treatment
 2215 lesions treated
 Outpatient therapy
 Sessions of 3-6 hours
 Ice patches used if illumination caused
tenderness
Results
 91% CR- Defined as total lesion elimination
with healing
 9% PR- Defined as >50% reduction in lesions
size without growth
 Minimum f/u 3 months (median=9 months)
Treatment Findings
 All pts underwent outpatient therapy w/o complications
 All therapy given as prescribed
 No photosensitivity reaction
 Pain control is excellent
 Itching and symptoms removed
Conclusions




PDT is well tolerated
Response is excellent
Morbidity is acceptable
The drug and light dose used offers good
outcome
 PDT does not stop additional therapy if
needed.
Summary
 PDT can offer excellent palliation
 Outpatient procedure
 Pts who have had extensive surgery, XRT and
chemo can respond well and heal
 Use PDT earlier in treatment course
Treatment Day
3 months followup
Other PS used for breast
cancer
 * Purlytin
Allison: 9pts, 1.2 mg/kg, 90% CR, minimal morbidity
 * Foscan
Wyss: 7pts, 0.15 mg/kg, 90% response, 90 %
morbidity (tissue slough)
 *Phthalocyanine (Pc4)
Oleinick: 2pts, .135 mg/m2, Minimal response
 *Motexafin Lutetium
Hahn: 5pts, 5 mg/kg, morbid
Breast




Surg, XRT: Excellent local control
PDT to lumpectomy bed + XRT to breast
PDT to lumpectomy bed alone!
PDT to chestwall even in heavily pre-txd tissue:
Excellent local control and cosmesis
 PDT for Dx via fluorescence
 Many questions on dose, timing, and technique
 Immune modulation via PDT?!