Photodynamic Therapy in Treating Patients With Resectable Non-Small Cell Lung Cancer That Has Spread to the Pleura

Study Overview
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Brief Summary
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RATIONALE: Photodynamic therapy uses a drug, such as porfimer sodium, that is absorbed by tumor cells. The drug becomes active when it is exposed to light. When the drug is active, tumor cells are killed. Giving photodynamic therapy during surgery may kill any tumor cells that remain after surgery. PURPOSE: This phase II trial is studying the side effects and how well photodynamic therapy given during surgery works in treating patients with resectable non-small cell lung cancer that has spread to the pleura.

Detailed Description
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OBJECTIVES: Primary To determine the overall survival rate of patients with non-small cell lung cancer (NSCLC) and malignant pleural spread treated with standard front-line chemotherapy followed by surgical resection and intra-operative porfimer sodium (Photofrin®)-mediated photodynamic therapy. To determine the feasibility and toxicities of standard front-line chemotherapy followed by surgical resection and intra-operative Photofrin®-mediated photodynamic therapy in these patients. Secondary To determine the progression-free survival and pleural progression-free survival of these patients. To determine the absolute Photofrin® levels in tumor and normal tissues resected from these patients using spectrofluorometric methods. To determine the tumor to normal tissue ratios of Photofrin® in these patients. To measure the optical properties of tumor and normal tissues in situ. To compare the Photofrin® concentration of tumor and normal tissues made with the in situ measurements to the measurements made with spectrofluorometric method. OUTLINE: This is a multicenter study. Patients receive 2-4 courses of standard front-line chemotherapy prior to surgery (if they have not completed the front-line chemotherapy). Patients receive porfimer sodium (Photofrin®) IV over 5-15 minutes. Approximately 24 hours after receiving porfimer sodium, patients undergo surgery to remove the primary tumor and the pleural disease to a thickness of 5 mm or less*. Patients then undergo intraoperative photodynamic therapy to the residual disease. Some patients may undergo postoperative radiotherapy to the mediastinum and/or surgical scar if clinically indicated. NOTE: *If the disease cannot be resected to less than 5 mm, PDT will not be delivered Tumor and normal tissue samples are obtained from the surgical specimen and examined prior to light delivery at the time of thoracotomy, and after light delivery. Tissue samples are analyzed for porphyrin levels using a spectrofluorometric assay of tissue specimens and an in situ optical method intra-operatively. Samples are also assessed for V-cadherin, markers for oxidative stress, markers associated with photosensitizer uptake, markers for angiogenesis, markers for hypoxia, activation of signaling pathway components (including EGFR, p38 MAPK, Akt, and p42/44 MAPK) via immunohistochemistry. After completion of study treatment, patients are followed periodically for 2 years.

Official Title
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A Phase II Study of Pleural Photodynamic Therapy for Patients With Non-small Cell Lung Cancer and Pleural Spread

Conditions
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Lung Cancer, Metastatic Cancer

Intervention / Treatment
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* Drug: chemotherapy
* Drug: porfimer sodium
* Other: immunohistochemistry staining method
* Other: laboratory biomarker analysis
* Procedure: spectroscopy
* Procedure: therapeutic conventional surgery


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically confirmed non-small cell lung cancer (NSCLC) Must have clinical and/or pathological evidence of pleural spread Primary tumor must be resectable as assessed by the attending thoracic surgeon Patients who have received or are currently receiving two-to-four courses of standard front-line chemotherapy are eligible PATIENT CHARACTERISTICS: Must be medically fit to tolerate surgery No CTCAE v3.0 grade III-IV elevations in liver transaminases Bilirubin ≤ 1.5 mg/dL No known HIV infection Not pregnant or nursing PRIOR CONCURRENT THERAPY: See Disease Characteristics No prior treatment for NSCLC except pleurodesis or standard front-line chemotherapy No prior pemetrexed disodium chemotherapy No prior mantle radiotherapy No concurrent chemotherapy or radiotherapy during the active study treatment period Post-operative radiotherapy will be administered as clinically indicated

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 120 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Photodynamic Therapy<br>PDT | Drug: chemotherapy<br> <br> Drug: porfimer sodium<br> <br> Other: immunohistochemistry staining method<br> <br> Other: laboratory biomarker analysis<br> <br> Procedure: spectroscopy<br> <br> Procedure: therapeutic conventional surgery<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Toxicity Assessment of Pleural Photodynamic Therapy | Toxicities of PDT as defined by CTCAE v4.0 | One year | 
| Overall Survival | Subject survival post PDT | 5 years | 
| Pleural Progression-free Survival | Amount of time from PDT to disease progression in pleura | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression-free Survival | Amount of time from PDT to disease progression at any site in the body | 5 years | 
| Photofrin® Uptake | Measured uptake of PDT drug | 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stage IIIA non-small cell lung cancer, stage IIIB non-small cell lung cancer, malignant pleural effusion