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• W3206342459 abstract "TOPIC: Lung Cancer TYPE: Fellow Case Reports INTRODUCTION: It is well established that photodynamic therapy (PDT) results in both direct tumor cell death as well as immune cell stimulation through processing of antigens from destroyed tumor cells by dendritic cells, which in turn serve as antigen presenting cells to T cells. However, tumor cells adapt varying degrees of immune cell evasion. Systemic immunotherapy with blockade of programmed death 1 (PD-1), programmed death ligand 1 (PD-L1), and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) is increasingly used to treat various cancers. CASE PRESENTATION: Our patient is a 55-year-old male smoker with a history of stage III (T3N1M0) non-small cell lung cancer (squamous) of the right lower lobe who is status post definitive treatment with carboplatin/taxol and radiation therapy followed by maintenance durvalumab. Several months after treatment, he underwent bronchoscopy that showed endobronchial lesions in the left and right upper lobes as well as in the left lower lobe. Pathology showed squamous cell carcinoma in situ features suspicious for superficial invasion. The decision was made to perform endobronchial photodynamic therapy (PDT) using 630 nm laser at a dose of 200 Joules/cm. In the days after PDT, he routinely underwent repeat bronchoscopy for removal of necrotic tissue resulting from the treatment. However, at one month post-PDT treatment, surveillance bronchoscopy showed ongoing inflammatory changes and necrotic tissue which again required debridement with cryotherapy. He appeared to have a particularly robust response to the PDT therapy which was evident on serial bronchoscopies. DISCUSSION: It is unclear whether the robust response to PDT while on darvalumab was beneficial, detrimental, or neutral to our patient. There are interesting recent experiments using mouse cancer models that show that combining PDT induces increased tumor expression of PD-L1, and that combining local PDT with systemic immunotherapy may actually potentiate the effects of immunotherapy even at distant metastases (Bao et al., Xu et al.). In humans, it is possible that a PDT dose adjustment is needed for patients on systemic immunotherapy. Alternatively, since this robust response was likely the result of increased immunologic activity, it is possible that more immunologic memory is generated which could protect against recurrence or distant spread.Our current arsenal to treat cancer has many modalities, including surgery, chemotherapy, immunotherapy, radiation therapy, and endoscopic modalities. As more modalities are developed and refined, it is crucial to investigate how they can be combined synergistically to provide the best outcomes for patients. CONCLUSIONS: It is unclear whether systemic immunotherapy has an impact on PDT in humans. As both modalities rely on patients' immune systems, studying the combination of PDT with immunotherapy is a compelling area for future research. REFERENCE #1: Shafirstein G et al. Photodynamic Therapy of Non-Small Cell Lung Cancer. Narrative Review and Future Directions. Ann Am Thorac Soc. 2016 Feb;13(2):265-75 REFERENCE #2: Bao R et al. Enhancing Anti-PD-1/PD-L1 Immune Checkpoint Inhibitory Cancer Therapy by CD276-Targeted Photodynamic Ablation of Tumor Cells and Tumor Vasculature. Mol Pharm. 2019 Jan 7;16(1):339-348. REFERENCE #3: Xu J et al. Near-Infrared-Triggered Photodynamic Therapy with Multitasking Upconversion Nanoparticles in Combination with Checkpoint Blockade for Immunotherapy of Colorectal Cancer. ACS Nano. 2017 May 23;11(5):4463-4474. DISCLOSURES: No relevant relationships by Martin Vonau, source=Web Response Consultant relationship with Pinnacle Biologics Please note: $1001 - $5000 by Benjamin Young, source=Web Response, value=Consulting fee Removed 04/20/2021 by Benjamin Young, source=Web Response Consultant relationship with Auris Surgical Robotics Please note: $1001 - $5000 by Benjamin Young, source=Web Response, value=Consulting fee Removed 04/20/2021 by Benjamin Young, source=Web Response Consultant relationship with Pinnacle Biologics Please note: 2018-2019 Added 04/30/2021 by Benjamin Young, source=Web Response, value=Consulting fee" @default.
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• W3206342459 date "2021-10-01" @default.
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• W3206342459 title "ROBUST INFLAMMATORY RESPONSE AFTER BRONCHOSCOPIC PHOTODYNAMIC THERAPY IN A PATIENT ON IMMUNOTHERAPY" @default.
• W3206342459 doi "https://doi.org/10.1016/j.chest.2021.07.1380" @default.
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