Phase I/II study of verteporfin photodynamic therapy in locally advanced pancreatic cancer
Mené sur 15 patients atteints d'un cancer du pancréas de stade localement avancé et inopérable, cet essai de phase I/II évalue la faisabilité et la toxicité d'une photothérapie dynamique utilisant la vertéporfine comme agent photosensibilisant
Background : Patients with pancreatic cancer have a poor prognosis apart from the few suitable for surgery. Photodynamic therapy (PDT) produces localised tissue necrosis but previous studies using the photosensitiser meso-tetrahydroxyphenylchlorin (mTHPC) caused prolonged skin photosensitivity. This study assessed a shorter acting photosensitiser, verteporfin. Methods : Fifteen inoperable patients with locally advanced cancers were sensitised with 0.4mgkg−1 verteporfin. After 60–90min, laser light (690nm) was delivered via single (13 patients) or multiple (2 patients) fibres positioned percutaneously under computed tomography (CT) guidance, the light dose escalating (initially 5J, doubling after each three patients) until 12mm of necrosis was achieved consistently. Results : In all, 12mm lesions were seen consistently at 40J, but with considerable variation in necrosis volume (mean volume 3.5cm3 at 40J). Minor, self-limiting extrapancreatic effects were seen in multifibre patients. No adverse interactions were seen in patients given chemotherapy or radiotherapy before or after PDT. After PDT, one patient underwent an R0 Whipple’s pancreaticoduodenectomy. Conclusions : Verteporfin PDT-induced tumour necrosis in locally advanced pancreatic cancer is feasible and safe. It can be delivered with a much shorter drug light interval and with less photosensitivity than with older compounds.