Photodynamic therapy for hilar bile duct cancer: clinical evidence for improved tumoricidal tissue penetration by temoporfin.

Abstract

Photodynamic therapy (PDT) has been established for palliation of non-resectable hilar bile duct cancer (hBDC). Ablation of hBDC using porfimer (P-PDT) improves cholestasis and survival. However, the tumoricidal effect is confined to the inner 4 mm of the tumor wall. Here, we have studied whether temoporfin PDT (T-PDT) shows an efficient local response and an increased tumoricidal penetration depth. In the first stage of a phase-II trial (NCT01016002), eleven patients with hBDC (Bismuth III-IV) were treated with T-PDT plus stenting and 10 could be analyzed for local tumor response. T-PDT resulted in complete local response in n = 1 of 10 patients, partial response in n = 8 and no response in one patient (occluded right hepatic duct re-opened but positive for residual tumor cells) - indicating a tumoricidal efficacy of 90%. Four patients showed a tumoricidal depth of ≥7.5 mm. Cholestasis and palliation improved in 8 patients with an overall median survival of 18 (4.4-32.0) months after the first T-PDT. Adverse events were phototoxic skin reaction (n = 4), cholangitis (n = 3), and liver abscess (n = 3). T-PDT doubles the depth of the local tumor-ablative effect of P-PDT, is highly tumoricidal and is associated with similar rates of infectious complications and grade I and II skin phototoxicity.

• Authors: Andrej Wagner, Tobias Kiesslich, Daniel Neureiter, Paul Friesenbichler, Andreas Puespoek, Ulrike W Denzer, Gernot W Wolkersdörfer, Klaus Emmanuel, Ansgar W Lohse, Frieder Berr
• Journal: Photochemical & photobiological sciences : Official journal of the European Photochemistry Association and the European Society for Photobiology (Photochem Photobiol Sci) Vol. 12 Issue 6 Pg. 1065-73 (Jun 2013) ISSN: 1474-9092 [Electronic] England
• PMID: 23558738 (Publication Type: Clinical Trial, Phase II, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents
• Mesoporphyrins
• Photosensitizing Agents
• temoporfin

Topics

• Aged
• Aged, 80 and over
• Antineoplastic Agents (therapeutic use)
• Bile Duct Neoplasms (drug therapy, pathology)
• Bile Ducts (drug effects, pathology)
• Female
• Humans
• Male
• Mesoporphyrins (therapeutic use)
• Middle Aged
• Photochemotherapy (adverse effects)
• Photosensitizing Agents (therapeutic use)