EUS-guided verteporfin photodynamic therapy for pancreatic cancer

Background and Aims Locally advanced pancreatic cancer (LAPC) often causes obstruction. Verteporfin photodynamic therapy (PDT) can feasibly “debulk” 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 included significant metastatic disease burden, disease involving >50% duodenal or major artery circumference, and recent treatment with curative intent. CT was obtained between day -28 to 0. On day 0, verteporfin 0.4 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. Primary outcome was presence of necrosis. Results Of 8 patients (62.5% male, mean age 65±7.9 y) included in the study, 5 were staged at T3, 2 at T2, and 1 at T1. Most (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 (day 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.