Photodynamic Therapy Of Cancer

Abstract

Photodynamic therapy (PDT) has been used experimentally in cancer patients since 1976, with an estimated 3,000-4,000 patients treated world-wide, most since 1982. Phase III, comparative randomized clinical trials are under way for regulatory approval of Photofrin® II, a purified version of hematoporphyrin derivative (Hpd). Several recent advances in both the clinical application of PDT and basic understanding of mechanisms are noteworthy. For example, it is now recognized that the photosensitizer undergoes photobleaching during treatment which may provide a therapeutic advantage in treatment. Clinical trials using lower drug doses seem to be consistent with this expectation. Advances in light delivery systems and dosimetry have also been achieved. It is now clear that in at least some experimental animal tumors, destruction of the vasculature system in both the tumor and surrounding normal tissue is necessary for 'cure', a process which may involve release of inflammatory and other factors. It is unclear if this is relevant to humans. Because of the problem of cutaneous photosensitivity and other factors, a search for other photo-sensitizers is being carried out by several groups, with early encouraging results being reported for certain phthalocyanines, purpurins and others.