Photodynamic therapy (PDT) using HPPH for the treatment of precancerous lesions associated with Barrett's esophagus.
Photodynamic therapy (PDT) using HPPH for the treatment of precancerous lesions associated with Barrett's esophagus.
复制标题
DOI：
10.1002/lsm.21112
复制
发表时间：
2011-09
影响因子：
2.4
通讯作者：
Henderson, Barbara W.
中科院分区：
文献类型：
--
作者：
Nava, Hector R.;Allamaneni, Shyam S.;Dougherty, Thomas J.;Cooper, Michele T.;Tan, Wei;Wilding, Gregory;Henderson, Barbara W.
FDA批准用于治疗Barrett食管癌前病变的porfimer钠光动力疗法（PDT）可引起6-8周的光敏性。HPPH（2-[1-己氧基乙基]-2-去乙烯基焦脱镁叶绿酸-a）在临床前研究中显示出持续时间短的最小光敏性和有希望的功效。在这里，我们探讨毒性和最佳的药物和光剂量与内镜HPPH-PDT。我们也想知道一次性HPPH-PDT治疗的疗效。对活检证实的食管高度异型增生或早期粘膜内腺癌进行了两项非随机剂量递增研究（各18例患者）。HPPH剂量范围为3至6 mg/m2。在HPPH给药后24或48小时，病变接受一次内窥镜暴露于150、175或200 J/cm的665 nm光。大多数患者发生轻度至中度胸痛，仅需对症治疗。6例患者发生3级和4级不良事件（16.6%）。三例食管狭窄通过扩张治疗。未出现明显的剂量依赖性毒性模式。在药物剂量范围研究中（48小时光剂量为150 J/cm），3和4 mg/m2的HPPH最有效。在光剂量范围研究（3或4 mg/m2 HPPH，24 h光照）中，1年时完全缓解率（高度异型增生和早期癌消失）为72%，所有接受3 mg/m2 HPPH +175 J/cm和4 mg/m2 HPPH +150 J/cm治疗的患者在1年时均显示完全缓解。HPPH-PDT治疗Barrett食管癌前病变似乎是安全的，并显示出有希望的疗效。需要进一步的临床研究来建立HPPH-PDT的使用。
Photodynamic therapy (PDT) with porfimer sodium, FDA approved to treat premalignant lesions in Barrett’s esophagus, causes photosensitivity for 6-8 weeks. HPPH (2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-a) shows minimal photosensitization of short duration and promising efficacy in preclinical studies. Here we explore toxicity and optimal drug and light dose with endoscopic HPPH-PDT. We also want to know the efficacy of one time treatment with HPPH-PDT. Two nonrandomized dose escalation studies were performed (18 patients each) with biopsy-proven high grade dysplasia or early intramucosal adenocarcinoma of esophagus. HPPH doses ranged from 3 to 6 mg/m2. At 24 or 48 hours after HPPH administration the lesions received one endoscopic exposure to 150, 175 or 200 J/cm of 665 nm light. Most patients experienced mild to moderate chest pain requiring symptomatic treatment only. Six patients experienced Grade 3 & 4 adverse events (16.6%). Three esophageal strictures were treated with dilatation. No clear pattern of dose dependence of toxicities emerged. In the drug dose ranging study (light dose of 150 J/cm at 48 h), 3 and 4 mg/m2 of HPPH emerged as most effective. In the light dose ranging study (3 or 4 mg/m2 HPPH, light at 24 h), complete response rates (disappearance of high grade dysplasia and early carcinoma) of 72% were achieved at 1 year, with all patients treated with 3 mg/m2 HPPH plus 175 J/cm and 4 mg/m2 HPPH plus 150 J/cm showing complete responses at 1 year. HPPH-PDT for precancerous lesions in Barrett’s esophagus appears to be safe and showing promising efficacy. Further clinical studies are required to establish the use of HPPH-PDT.
登录
查看更多内容
影响因子：
158.5
作者：
Shaheen, Nicholas J.;Sharma, Prateek;Lightdale, Charles J.
通讯作者：
Lightdale, Charles J.
影响因子：
24.5
作者：
Hage, M;Siersema, PD;Kuipers, EJ
通讯作者：
Kuipers, EJ
影响因子：
7.7
作者：
Overholt, BF;Lightdale, CJ;Depot, M
通讯作者：
Depot, M
影响因子：
2.4
作者：
Panjehpour, Masoud;Overholt, Bergein F.
通讯作者：
Overholt, Bergein F.
影响因子：
29.4
作者：
Prasad, Ganapathy A.;Wang, Kenneth K.;Borkenhagen, Lynn S.
通讯作者：
Borkenhagen, Lynn S.