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New methods Clinical endoscopy| Volume 94, ISSUE 1, P179-186, July 2021

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EUS-guided verteporfin photodynamic therapy for pancreatic cancer

Published:February 25, 2021DOI:https://doi.org/10.1016/j.gie.2021.02.027
EUS-guided verteporfin photodynamic therapy for pancreatic cancer
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      Background and Aims

      Locally advanced pancreatic cancer (LAPC) often causes obstruction. Verteporfin photodynamic therapy (PDT) can feasibly “debulk” the tumor more safely than noncurative surgery and has multiple advantages over older PDT agents. We aimed to assess the feasibility of EUS-guided verteporfin PDT in ablating nonresectable LAPC.

      Methods

      Adults with LAPC with adequate biliary drainage were prospectively enrolled. Exclusion criteria were significant metastatic disease burden, disease involving >50% duodenal or major artery circumference, and recent treatment with curative intent. CT was obtained between days –28 to 0. On day 0, verteporfin .4 mg/kg was infused 60 to 90 minutes before EUS, during which a diffuser was positioned in the tumor and delivered light at 50 J/cm for 333 seconds. CT was obtained on day 2, with adverse event monitoring occurring on days 1, 2, and 14. The primary outcome was presence of necrosis.

      Results

      Of 8 patients (62.5% men, mean age 65 ± 7.9 years) included in the study, 5 were staged at T3, 2 at T2, and 1 at T1. Most (n = 4) had primary lesions in the pancreatic head. Mean pretrial tumor diameter was 33.3 ± 13.4 mm. On day 2 CT, 5 lesions demonstrated a zone of necrosis measuring a mean diameter of 15.7 ± 5.5 mm; 3 cases did not develop necrosis. No adverse events were noted during the procedure or postprocedure observation period (days 1-3), and no changes in patient-reported outcomes were noted.

      Conclusions

      In this pilot study, EUS-guided verteporfin PDT is feasible and shows promise as a minimally invasive ablative therapy for LAPC in select patients. Tumor necrosis is visible within 48 hours after treatment. Patient enrollment and data collection are ongoing. (Clinical trial registration number: NCT03033225.)

      Abbreviations:

      LAPC (locally advanced pancreatic cancer), PDT (photodynamic therapy)
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      Article info

      Publication history

      Published online: February 25, 2021
      Accepted: February 18, 2021
      Received: September 29, 2020

      Footnotes

      DISCLOSURE: The following author received research support in part for this study from the University College London Hospitals/University College London Comprehensive Biomedical Centre, which receives a proportion of funding from the UK Department of Health's National Institute for Health Research Biomedical Research Centre funding scheme: S. P. Pereira. In addition, the following author disclosed financial relationships: K. K. Wang: Research support from Fuji Medical and CSI; consultant for Ironwood Pharmaceuticals. All other authors disclosed no financial relationships. Research support for this study was provided by the National Institutes of Health grant P01 CA084203. None of these organizations were involved in the statistical analysis, interpretation of the results, or writing of this manuscript.

      Identification

      DOI: https://doi.org/10.1016/j.gie.2021.02.027

      Copyright

      © 2021 by the American Society for Gastrointestinal Endoscopy

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