A phase II/III clinical study of tin ethyl etiopurpurin (Purlytin)-inducedphotodynamic therapy for the treatment of recurrent cutaneous metastatic breast cancer

BACKGROUND Chest wall recurrence of breast cancer after mastectomy, radiati on therapy, and chemotherapy poses a therapeutic dilemma. Further intervent ion with any or all of these modalities is often futile and morbid. Left un treated, se vere pain, infection, and suffering occur. OBJECTIVE To ascertain whether photodynamic therapy may present a palliativ e option for these individuals. METHODS A total of 86 lesions (2.4-cm mean diameter) were treated on eight patients who had biopsy-proven chest wall recurrence despite surgery, chemo therapy, and radiation therapy. Each patient underwent a single photodynami c therapy session in which 1.2 mg/kg of the drug tin ethyl etiopurpin (Purl ytin) was injected and followed 24 hours later by laser light treatment at 660 +/- 3 nm (at 150 mW/cm(2) for a total light dose of 200 J/cm(2)). RESULTS With a minimum G-month follow-up, the objective response rates afte r photodynamic therapy were complete response, 92%; partial response, 8%; a nd no response, 0%. Lesions less than 0.5 cm had a 100% complete response. Morbidity was minimal with no systemic toxicity, One patient had a wound in fection that responded to oral antibiotics. No photosensitivity reactions w ere reported in this set of patients. Posttreatment pain was reported and c ould be treated with medication and application of cold compresses. CONCLUSIONS Photodynamic therapy offers an excellent local control rate of chest wall recurrence with minimal morbidity after multimodality treatment failure, The treatment is given in a single session and on an outpatient ba sis. In patients who may register a partial response or have recurrence or the incidence of further chest wall nodules after photodynamic therapy, the treatment is repeatable.