Photodynamic Therapy Using Talaporfin Sodium for Local Failure after Chemoradiotherapy or Radiotherapy for Esophageal Cancer: A Single Center Experience.

Moriya Iwaizumi,Takahisa Furuta,Natsuki Ishida,Ken Sugimoto,Shinya Tani,Masanao Kaneko,Mihoko Yamade,Satoshi Osawa,Yasushi Hamaya,Satoshi Tamura,Takahiro Miyazu

doi:10.3390/jcm9051509

Moriya Iwaizumi, Takahisa Furuta + Show 9 more

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https://doi.org/10.3390/jcm9051509

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Abstract

A phase II study of second-generation photodynamic therapy (PDT) using talaporfin sodium has shown excellent treatment results for esophageal cancer with local failure after chemoradiotherapy (CRT) or radiotherapy (RT). However, only a few studies have reported this therapy in clinical practice. This study aimed to confirm the efficacy and safety of salvage PDT using talaporfin sodium for esophageal cancer in various clinical situations. Twelve patients with esophageal cancer with local failure after definitive CRT or RT who underwent PDT using talaporfin sodium were enrolled from April 2016 to January 2020. Overall, 10 patients (83.3%) achieved a local complete response. No skin phototoxicity was observed, but esophageal stricture occurred in five patients (41.7%). Esophageal stricture was improved with endoscopic balloon dilation in all patients, and subsequent analysis found no significant factors causing esophageal stricture after PDT. Two patients with synchronous tumors were successfully rescued by combination therapy with endoscopic submucosal dissection. Two patients with carcinoma in situ of larger than 1/2 circumference were rescued by repeated PDT. The 2-year overall survival was 80.0% (95% confidence interval 0.409–0.946). PDT using talaporfin sodium was an effective and safe salvage treatment for esophageal cancer with local failure after CRT or RT in various clinical situations.

Highlights

Definitive chemoradiotherapy (CRT) is a non-surgical curative option in patients with inoperable, locally advanced lesions or in those who decline to be surgically treated even in the operable stage of esophageal cancer [1,2,3,4]
Yano et al reported the favorable results of a phase II study examining the local complete response (L-CR) of Photodynamic therapy (PDT) using talaporfin sodium for esophageal cancer with local failure after CRT or RT [20]; according to the results of this clinical study, PDT using talaporfin sodium was approved in Japan at October 2015 [21]
All the patients were diagnosed with squamous cell carcinoma (SCC), and eight (66.7%) had clinical stage (cStage) I at initial treatment

Summary

Introduction

Definitive chemoradiotherapy (CRT) is a non-surgical curative option in patients with inoperable, locally advanced lesions or in those who decline to be surgically treated even in the operable stage of esophageal cancer [1,2,3,4]. A considerable number of patients develop locoregional failure after definitive CRT or RT [1,5], and salvage therapy is necessary for local recurrence or residual lesions [6,7]. First-generation PDT for esophageal cancer using porfimer sodium (Photofirin; Pfizer Japan Inc., Tokyo, Japan) has some disadvantages such as a long sun shade period of approximately 6 weeks to avoid the risk of skin phototoxicity and the need for an expensive excimer dye laser system [15,16,17]. Second-generation PDT using talaporfin sodium (Laserphyrin; Meiji Seika Pharma Co., Ltd., Tokyo, Japan) requires a shorter sun shade period of approximately 2 weeks and has a low frequency of skin phototoxicity [11,18,19]. Only few clinical studies have reported this treatment because it is currently only being performed at limited centers

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