Photodynamic Therapy Center

Photodynamic Therapy at Roswell Park Cancer Institute

Photodynamic therapy (PDT) was developed at RPCI, and the PDT Center is a worldwide leader in its use for treating many types of cancer.

PDT, developed in the late 1970s by Thomas Dougherty, PhD, Chief Emeritus of the Center, is a targeted anticancer treatment — one that kills tumor cells without permanently damaging surrounding tissue. The treatment involves the administration of a nontoxic drug that settles in tumor cells, followed by the application of laser light to the tumor, thereby activating the drug and killing the cancer. At RPCI, it is used to treat various types of cancer, including cancers of the skin, lung, breast, gynecological cancers, esophagus, pleura, head and neck - mouth and larynx.

Please direct general and disease-specific questions to:

Photodynamic Therapy Nurse - Michele Cooper, RN, OCN
(716) 845-4427
Email: pdtnurse@roswellpark.org

Mailing Address
PDT Center
Roswell Park Cancer Institute
Elm & Carlton Streets
Buffalo, NY 14263

What is Photodynamic Therapy (PDT)?

Photodynamic therapy, or PDT, is a two-step treatment that uses a light sensitive drug (photosensitizer) and non-thermal (without heat) visible red light (from a laser or other light source) to destroy the cancer cells in solid tumors. PDT using the drug Photofrin® (porfimer sodium) has been approved for various applications worldwide (in Canada, bladder and esophageal cancer; in The Netherlands, lung and esophageal cancer; in Japan, early lung cancer; in France, early and late stage lung cancer; in Germany, early lung cancer). Photofrin®-PDT has been approved by the U.S. Food & Drug Administration for the palliative treatment of advanced esophageal cancer, Barrett’s esophagus with high grade dysplasia, advanced lung cancer (obstruction tumors located in the airway), and the treatment of early stage lung cancer (located in the airway) with curative intent. 

Photofrin® is also used for off-label treatment (these are treatments not approved by FDA for these indications and no clinical trial is available, but the use for these indications is supported by peer-reviewed medical literature) of various solid tumors. These cancers include head and neck cancers, some gynecological cancers in vagina, vulva and cervix, skin cancers, perianal cancers, metastatic breast cancer to skin, and other cancers.

Since the 1970’s PDT treatments with Photofrin® have taken place here at RPCI.  Thousands more have been carried out worldwide. Several other 2nd generation photosensitizers, in addition to Photofrin®, are being evaluated at RPCI. For example, Photochlor® (commonly called HPPH) has been used in patients since 1999. Over 150 patients here at RPCI, as well as at the University of Pennsylvania in Philadelphia, have been treated with HPPH-PDT for esophageal cancer, lung cancer (bronchus), Barrett’s esophagus with high grade dysplasia and esophageal cancer, breast cancer and various skin cancers. There are ongoing clinical trials for treatment of head and neck cancer, pleural malignancy (intraoperative PDT) and lung cancer.

Photofrin® and HPPH are administered intravenously over a short period of time. However, there are also other drugs used in the treatment of skin cancers that are topically applied (applied directly to the skin) that can be converted by skin cancer cells into a photosensitizer that can be activated by light.

Photodynamic Therapy with Photofrin®

How Photofrin®-PDT Works
A non-toxic drug called Photofrin® (porfimer sodium) is injected intravenously. Both normal and malignant cells absorb the drug. However, two to three days later Photofrin® concentrates in the cancer cells and is reduced in the normal cells that are near many cancers. Non-thermal (without heat) red light, which is typically generated by a laser, is focused on the tumor. This light activates the Photofrin®, causing an almost immediate destruction of the tumor cells.

Photofrin® is a photosensitizing drug and it is retained for some time by skin. Because of this, patients are required to avoid direct sunlight for a period of 4-6 weeks after injection. Patients are advised to avoid very bright artificial lights (like a dentist's lamp or physician's examining light) or strong residential direct indoor lighting (like spotlights and floodlights) for this period of time. Sunglasses, dark-colored clothing, long-sleeved shirts, hat, gloves and long pants must be worn to protect the skin when the patient is outdoors. Patients are also cautioned to avoid cone- or helmet-type hairdryers for one month after Photofrin® injection (since extreme heat might activate the drug retained in the scalp). These light, or heat, exposures produce a photosensitivity-type reaction resulting in redness and swelling of the skin.

Tumors Treated by PDT

Microinvasive (Early) Endobronchial Non-small Cell Lung Cancer
The US FDA has approved Photofrin®-PDT for the treatment of microinvasive (early) Endobronchial non-small cell lung cancer in patients for whom surgery and radiotherapy are not indicated. The cancer must be located in an airway and be reachable using a bronchoscope (a flexible instrument used to visualize the airways). Photofrin® is injected intravenously and the tumor is exposed to red light two days later during a bronchoscopy. This procedure may be done under local or general anesthesia. Two days later a "clean-up" bronchoscopy, where dead tumor cells and debris are removed, is performed under local or general anesthesia.

For more information about PDT and lung tumors contact the PDT Center, Todd Demmy, MD; Sai Yendamuri, MD; Samjot Dhillon, MD; or Chumy Nwogu, MD, at 1-800-ROSWELL.

Endobronchial Lung Tumors (Advanced)
Photofrin®-PDT has been approved by the US FDA for certain early- and late-stage lung tumors. Tumors must be accessible via a bronchoscope. The drug-activating red light is delivered by way of optical fibers that are threaded through the bronchoscope. PDT is done under local or general anesthesia two days after Photofrin® injection. Three days after light treatment a "clean-up" bronchoscopy is performed under local or general anesthesia. Dead tumor cells and debris are removed to open the airway to its fullest extent.

For more information about PDT and lung tumors contact the PDT Center, Todd Demmy, MD; Sai Yendamuri, MD; Samjot Dhillon, MD; or Chumy Nwogu, MD, at 1-800-ROSWELL.

Advanced, Partially or Totally Obstructing Cancer of the Esophagus
Photofrin®-PDT has been approved by the US FDA for palliative use in patients with advanced cancer of the esophagus, where the esophagus is totally or partially obstructed and the lesions are not suitable for treatment with thermal (with heat) laser therapy. The patient will receive an intravenous injection of Photofrin®. Two to three days later the patient will undergo an endoscopy to visualize the tumor and at the same time deliver the Photofrin®-activating red light. The side-effects of this therapy may include chest pain and burning, difficulty swallowing and possible stricture of the esophagus.

For more information about PDT and cancer of the esophagus, contact the PDT Center, Todd Demmy, MD; Hector Nava, MD; Sai Yendamuri, MD; or Chumy Nwogu, MD, at 1-800-ROSWELL.

Barrett's Esophagus with High Grade Dysplasia
To be eligible for this therapy, the patient must have high-grade dysplasia in conjunction with Barrett's esophagus. The patient will receive an intravenous injection of Photofrin®. Two to three days later the patient will undergo an endoscopy to visualize the area and at the same time deliver the laser light. The side-effects of this therapy may include chest pain and burning, difficulty swallowing and possible stricture of the esophagus. The treatment can be repeated if needed. Follow-up and examinations are very important after PDT treatment as they are after any therapy.

For more information about PDT and cancer of the esophagus, contact the PDT Center, Hector Nava, MD; Todd Demmy, MD; Sai Yendamuri, MD; or Chumy Nwogu, MD, at 1-800-ROSWELL.

Mouth Cancer and Dysplasia
PDT can be used effectively for cancers or dysplasia’s located in the mouth, including tongue, cheek, floor of the mouth, roof of the mouth and other areas. The patient will receive an intravenous injection of Photofrin®. Two to three days later non-thermal laser light will be directed onto their cancer or dysplasia.  Since the light may shine onto the area for up to 15 minutes, patients are taken into the operating room and anesthesia is used in most cases.  In a few cases this is not needed and it can be done with the patient awake.  Minimal pain is experienced during the treatment, but does develop over the next 1-3 days and can become severe. This pain is effectively managed with analgesics. After PDT, the treated area in the mouth will become red, swollen and uncomfortable and may eventually form a sore. Ulcers and sores in the mouth where the cancer or dysplasia was will generally heal with good results over the next 4 weeks.  Swelling (called edema) of the treated area and surrounding area is also expected and medication can be given to control this. The swelling lasts for several days after PDT. Mouth care and brushing teeth are important. This treatment can be performed multiple times if needed.

For more information about PDT and cancer of mouth, contact the PDT Center, Michele Cooper, RN at 1-800-ROSWELL.

Skin Cancers
Skin cancers are treated using PDT in conjunction with the Dermatology Department at RPCI. Basal cell carcinoma, the most common type of skin cancer, as well as squamous cell carcinoma, Bowen's disease and nevoid basal cell carcinoma syndrome (NBCCS) may be effectively treated using PDT. The photosensitizer-activating non-thermal red light is directed onto the skin cancer two to three days after Photofrin® injection. The treated skin may become red, swollen and uncomfortable and may eventually form a scab following PDT. The scab frequently falls off after two or three weeks. A second treatment may be required to completely destroy some larger skin cancers. Also underway is a study to treat solar keratosis, which is the most common premalignant lesion in light-skinned people. A drug called ALA, applied as a cream, can also be used in this application.

Breast Cancer (Skin Metastasis)
Local recurrences of breast cancer in the skin and chest wall following mastectomy are difficult to treat. Some such cases may be treatable with PDT. However, the nature of these recurrences limits the utility of PDT in this situation, and the prior treatment of the area with radiation can make effects on the normal tissue more severe. Other therapies, including additional radiation with or without hyperthermia, may be more appropriate. The PDT Center and Breast Program Staff will review individual cases for suitability of PDT, and discuss options with a patient's physician. There is no clinical trial available at this time, so PDT is treated off-label.

For more information about PDT and breast cancer recurrences, contact the PDT Center, Michele Cooper, RN, OCN, CCRC, at 1-800-ROSWELL.

Gynecologic Malignancies
Gynecologic tumors often occur in areas that are easily accessible to the activating light used in PDT. Photofrin®-PDT may be an effective treatment in certain cases that involve tumors of the vagina, vulva and cervix. In recurrent tumors this therapy has resulted in some long-lasting results. Treatment takes place two days after Photofrin® injection and usually lasts ½ to 1 hour. Local pain (pain in the area treated) is to be expected in the treatment field for several days to weeks following therapy, but this can be treated with analgesics.

There is no clinical trial available at this time, so PDT is used off-label (off-label treatments not approved by FDA for these indications and no clinical trial is available, but the use for these indications is supported by peer-reviewed medical literature).

For more information about PDT and gynecologic tumors, contact the PDT Center or Sashikant Lele, MD, at 1-800-ROSWELL.

PDT Using the 2nd Generation Photosensitizer Photochlor® (commonly called HPPH)

HPPH is utilized in the treatment of early lung cancers located in the bronchus, pleural cancers such as mesothelioma and cancers and dysplasia of the head and neck - mouth and larynx. HPPH is only used in clinical trials (that is, it is not approved by the FDA and there are no off-label treatments) at this time.

How HPPH-PDT Works
An intravenous injection of a non-toxic drug commonly called HPPH (Photochlor®) is given over 1 hour using an infusion pump. This drug is called a photosensitizer and is not a chemotherapeutic drug, that is, this drug does not work unless activated by non-thermal (no heat) red light. Both normal and malignant cells absorb this photosensitizer. However, one to two days after injection, HPPH is concentrated in the cancer cells and reduced in the normal cells that are near many cancers and in the skin. Red light, which is generated by a laser, is focused on the area of cancer or dysplasia. This light activates the HPPH, causing an almost immediate destruction of dysplastic or cancerous cells. The cancers or dysplasia slowly die off over the next several days or weeks.

The Side Effects of HPPH–PDT
HPPH is a photosensitizing agent and is retained in the skin. Because of this, patients are required to avoid direct sunlight for a period of 7-10 days on average after the infusion of the drug. Patients are advised to avoid very bright lights (i.e. a dentist's lamp or examining light) or strong residential direct indoor lighting (i.e., a direct spotlight, floodlight, etc.) for this period. Sunglasses, dark colored clothing, long sleeved shirts, hat, gloves and long pants must be worn to protect the skin when outdoors. Eye sensitivity to sunlight may occur in rare cases. Eye examinations which utilize bright light, such as direct and indirect ophthalmoscopy, slit lamp biomicroscopy (used to examine the retina of the eye), photostress tests (used to test exposure to light) should be avoided. Patients are also cautioned to avoid cone- or helmet-type hairdryers for 30 days after HPPH injection (since extreme heat may active the HPPH retained in the scalp and produce a photosensitivity-type reaction producing redness and swelling).

Like most drugs, HPPH (following activation by light) may cause all, some, or none of the side effects reported in other patients.  The side effects may be mild, moderate, or severe. In addition, there is always the small risk of other side effects occurring that are not yet known.  It is very important that anyone receiving HPPH-PDT notify their doctor right away about any side effects, problems, or unusual experiences they may have.  This will reduce the likelihood that the side effects continue or become more severe.   

Cancer and Dysplasia of the Head and Neck

Mouth Cancer and Dysplasia
PDT can be used effectively for cancer or dysplasia located in the mouth, including tongue, cheek, floor of the mouth, roof of the mouth and other areas. The patient is infused with the drug HPPH and approximately 24 hours later non-thermal red laser light is directed onto the area of cancer or dysplasia. Since the light may shine onto the area for up to 15 minutes, patients are taken into the operating room and anesthesia is used in most cases. In a few cases this is not needed and it can be done with the patient awake. Your physician will let you know if this procedure can be performed outpatient.  Minimal pain is experienced during the treatment, but does develop over the next 1-3 days and can become severe. This pain can be effectively managed with analgesics. After PDT, the treated area in the mouth will become red, swollen and uncomfortable, and may eventually form a sore. Ulcers and sores in the mouth where the cancer or dysplasia was will generally heal with good results over the next month.  Swelling (called edema) of the treated area and surrounding area is also expected and medication will be given to control this. This swelling lasts for several days after PDT. Mouth care and brushing teeth are important and instructions will be given to you. The majority of patients are outpatient, going home after the procedure with no need for admission. However, in some cases the patient may stay at RPCI overnight. Your physician will decide if admission is required. Remember: sun precautions must be followed for all treatments where HPPH or other intravenous photosensitizers (for example Photofrin®) are used.

For more information about PDT and cancer of mouth, contact the PDT Center, Michele Cooper, RN at 1-800-ROSWELL

Other Lung tumors, including Mesothelioma
It is possible to treat certain cancers within the lung or on the lining (pleura) of the lung with HPPH-PDT. PDT is performed following removal of the tumor while the patient is still in surgery. The photosensitizer-activating red light is directed into the lung cavity. Treatment time is determined by the size of the lung cavity and may last from 1-3 hours.  HPPH is given over 1hour, two days prior to the planned surgical removal of the cancer. The patient is protected from the operating room lights since the surgery can last several hours. The patient is hospitalized for 1-2 weeks or longer depending on the surgical procedure they undergo.

For more information about PDT and lung tumors contact the PDT Center, Todd Demmy, MD; Sai Yendamuri, MD; or Chumy Nwogu, MD, at 1-800-ROSWELL.

Microinvasive (Early) Endobronchial Non-small Cell Lung Cancer
HPPH-PDT is used in a clinical trial for the treatment of microinvasive (early) endobronchial non-small cell lung cancer in patients for whom surgery and radiotherapy are not indicated. The cancer must be located in an airway and reachable using a bronchoscope (a flexible instrument used to visualize the airways). HPPH is injected intravenously and the red laser light treatment is carried out two days later during a bronchoscopy.  This procedure may be done under local or general anesthesia.  Two days later a “clean-up” bronchoscopy is performed (under local or general anesthesia) where dead tumor and debris are removed. PDT does not usually cause any pain; however, debris and secretions may develop so it is very important to notify your physician immediately if you have any shortness of breath. Most patients are admitted after the procedure to monitor for this possible event for 1-2 days after PDT.

For more information about PDT and lung tumors contact the PDT Center, Todd Demmy, MD; Sai Yendamuri, MD, Samjot Dhillon, MD; or Chumy Nwogu, MD, at 1-800-ROSWELL.

Please direct general and disease-specific questions to:

Michele Cooper, RN, OCN, CCRC
(716) 845-4427
email: pdtnurse@roswellpark.org

Mailing Address
PDT Center
Roswell Park Cancer Institute
Elm & Carlton Streets
Buffalo, NY 14263