P3.04-009 Photodynamic Therapy (PDT) Turns 21: Indications, Applications and Outcomes for NSCLC: Topic: Miscellaneous I

Abstract

Photodynamic therapy (PDT) remains a novel ablative modality for managing NSCLC as it enters its 21st year since FDA approval. Initially proposed for definitive management of early NSCLC and palliative control for advanced NSCLC, PDT has grown beyond these limited indications to find broad applicability across the spectrum of NSCLC disease. This report details indications, applications, and outcomes from 2 centers with active PDT programs. Patients treated with PDT between 1998 and 2016 were entered retrospectively (prior to 2012) or prospectively (after 2013) into an IRB approved registry. All patients received a single photosensitizer, Photofrin, at a dose of 2 mg/kg IV. PDT was accomplished with lasers delivering light at 630 nm. Dosimetry ranged from 100 J- 200 J We defined a course of therapy as all light applications administered after a single injection of photosensitizer (range 1 - 3). Demographics, procedural details, clinical indications, clinical course and outcomes data were entered into the registry. These records were evaluated for this review. Our programs treated 812 patients with PDT; there were 210 females and 602 males. The age at treatment ranged from 21 to 91. We treated 458 patients with bronchogenic carcinoma. The stages included: stage 0 (5), stage 1 (48), stage 2 (38), stage 3a (82), stage 3b (97) stage 4 (116). 393 (85%) patients were managed with a single course of PDT; 65 patients were treated with multiple courses of PDT ranging from 2 - 6 times. Symptom management and palliation accounted for 63% of the indications. The majority of patients were treated with curative intent as part of a multimodality regimen. Photosensitivity was < 1%. There were no airway perforations. There was 1 bronchial stricture which occurred after a single course of PDT in a previously resected but not radiated patient. PDT for NSCLC is applied most often for advanced stage (3b/4) disease for management of airway symptoms. PDT can be used as a single definitive therapy for early stage disease and can be incorporated safely into a multimodality regimen which may include surgery, radiation and chemotherapy. Photosensitivity and airway injury are rare. Twenty one years after achieving FDA approval, PDT continues to have a place in managing patients with NSCLC. The favorable safety profile, compatibility with other therapies, and repeatability of courses of therapy suggest that we evaluate additional ways to apply PDT as endoscopic technology provides enhanced access to the airway and peripheral lung parenchyma.