Chair of Thoracic Surgery at Roswell Park, Dr. Sai Yendamuri, shares insights into an exciting phase I trial evaluating the side effects of intraoperative photodynamic therapy (PDT) with porfimer sodium in enhancing the response to immunotherapy with an immune checkpoint inhibitor drug in patients with non-small cell lung cancer with pleural disease. Developed at Roswell Park, PDT is a technique that works by combining a photosensitizing agent (porfimer sodium in this trial) and an intense light source to kill tumor cells. Photodynamic therapy may decrease the patients' symptoms and improve their quality of life.
So what we are excited about with this iteration of the plural PDT program at Roswell Park is our ability now to amplify the immune response of thoracic malignancies that have invaded the pleural cavity to make them more susceptible to immune therapeutic approaches. My name is Simon Memory. I serve as a professor and chair of thoracic surgery at Roswell Park. Apart from a robust clinical practice and complex thoracic oncology, I conduct several clinical trials and have a lab interest that's focused on translational research. So this trial is focused on the treatment of lung cancer patients with poor little disease. So these patients are patients who by definition are staged for lung cancer. They have few treatment modalities notwithstanding the presence of or the existence of immuno therapeutic options for these patients. As many of you know immunotherapy has changed the way we treat these patients. It works reasonably well in about a quarter of patients with advanced stage lung cancer. And what about the remaining three forts? Some of these patients have a modest response to immunotherapy and some of them don't respond to immunotherapy at all. What are called either cold or warm uh lung tumors. So our trial is trying to tackle these cold or warm uh lung cancers with pleural disease. And the way we hope to tackle this is by treating the pleural surfaces with humor in them with photodynamic therapy. And the idea here and this idea supported by plenty robust preclinical evidence is that the photodynamic therapy. Not only treats the tumor at the local level, but more importantly, it amplifies the immune response against the cancer. And this amplification of immune response makes the tumor not just there but everywhere else in the body more susceptible to immunotherapy. So that's the central idea that we're testing in this protocol. So currently the study is a phase phase one to trial. Typically the patient gets an injection of photo friend which is the B. D. D. Drug that we have used for the study They get it about 48 hours before the proposed surgery. Then the patient is taken to the operating room. A small incision is made after anesthesia. The malignant pleural effusion is evacuated. Um The optical surface applicator is actually placed into the chest. Uh And uh sort of threw a counterpunch. We actually pulled the applicator right against the chest wall and it's done in the direct vision. So we are sure we know where the PDT is is actually applied. We know it's not close to vital structures like the order or the esophagus or the airway and so on and so forth. And so it's done in a fairly safe manner. Once that is once that is done we take some tissues for correlative science studies and some blood samples for these patients for correlative science studies as well so that we can measure the immune response That's created by the photodynamic therapy. Uh so the entire treatment takes about 30-45 minutes at the end of this. We will put some top floor releases which is the reason the patient is on the table in the first place put in a chest tube, close our incisions. Once we are able to show in the Phase two trial that what we find in the pre clinical studies are replicated in patients. We plan a multi center trial to actually look at the ability of P. D. T. To amplify response to immunotherapy tick agents. So the key takeaway from this is that photodynamic therapy, which I invented Russell Park can amplify the immune response to make tumors are more susceptible to treatment with immunotherapy. With standard immunotherapy and that's the direction that's the area of exploration that we are so uh interested and excited about here.