Clinical outcome of photodynamic therapy in esophageal squamous cell carcinoma

Perspectives on photodynamic therapy combined with immunotherapy in treatment of colorectal cancer: An overview based on experimental studies

Colorectal cancer (CRC) is one of the major cancers threatening human health, with high mortality, tumor drug resistance and metastasis. Due to its advantages of non-invasive, strongly targeted and limited side effects, Photodynamic therapy (PDT) has become a promising treatment for CRC. Remarkably, PDT has been shown to activate T cell-adaptive immune response and induce immunogenic cell death (ICD). Used in combination with other treatment techniques, PDT has considerable promise in the management of colorectal cancer. In particular, the combination of PDT and tumor immunotherapy, the systemic anti-tumor immune response was enhanced more significantly. This strategy is expected to achieve a synergistic anti-tumor effect by inducing tumor cell apoptosis, regulating tumor immune microenvironment and effectively activating anti-tumor immunity during treatment process. This review focuses on the research of PDT combined with immunotherapy to improve the treatment of CRC. In most studies, a positive effect was observed for combination therapy, experimentally indicating new therapeutic opportunities for CRC.

Efficacy and safety of photodynamic therapy sequential dose-reduction concurrent chemoradiotherapy in locally advanced obstructive esophageal carcinoma: A propensity score matching analysis

BACKGROUND

Dysphagia is a major symptom in esophageal carcinoma (EC) patients. photodynamic therapy (PDT) was approved for palliative treatment of patients with obstructive EC. Although it can remove the obstruction quickly, PDT may be difficult to achieve eradication alone. Thus, we aimed to assess whether photodynamic therapy sequential Dose-Reduction concurrent chemoradiotherapy (CCRT) can be an effective and safe approach for locally advanced obstructive EC.

METHODS

This retrospective study included 121 patients with locally advanced obstructive EC who treated with radical CCRT (conventional treatment) and PDT sequential dose-reduction CCRT (combined treatment). A 1:1 propensity score matching (PSM) was conducted to balance potential bias. The improvement of dysphagia and overall survival (OS) was analyzed as the primary endpoint. Progression-free survival (PFS), local control, nutritional improvement and toxicities were analyzed as secondary endpoints.

RESULTS

After PSM, 15 pairs of patients were selected for final analysis. Although the data failed to identify discrepancy in the remission rate of dysphagia between the two groups (73.3 % VS 93.3 %, P = 0.33), the degree of dysphagia relief deviated significantly (2.13 ± 0.52 VS 2.47 ± 0.52, P = 0.005). The onset of dysphagia remission was earlier in the combined treatment group than in the conventional treatment group (17.29 ± 9.29 days VS 33.73 ± 6.77 days, P < 0.001). The median OS of conventional treatment group and combined treatment group were 21.10 months (95 %CI 10.24∼31.96) and 36.67 months (95 %CI 21.54∼51.80), respectively (P = 0.048). The median PFS were 14.30 months (95 %CI 7.79∼20.81) and 31.23 months (95 %CI 13.68∼47.78), respectively (P = 0.039). The rates of 1-year, 2-year and 3-year OS of conventional treatment and combined treatment group were 60 %, 33.3 %, 20 % and 86.7 %, 66.7 %, 41.5 %, respectively. The rates of 1-year, 2-year, and 3-year PFS of the two groups were 53.3 %, 26.7 %, 13.3 % and 73.3 %, 53.3 %, 38.1 %, respectively. The improvement of nutritional status in combined treatment group was better than that in conventional treatment group. The grade 3 toxicity rate was 46.7 %, and no grade 4 or more toxicity was observed in all patients. The addition of PDT did not increase the risk of toxic reactions compared with concurrent chemoradiotherapy.

CONCLUSION

Photodynamic therapy sequential dose-reduction concurrent chemoradiotherapy can rapidly relieve dysphagia symptoms in patients with locally advanced obstructive EC. Compared with radical CCRT, it does not increase the incidence of treatment-related adverse reactions.

Gelatin/Chitosan Films Incorporated with Curcumin Based on Photodynamic Inactivation Technology for Antibacterial Food Packaging

Photodynamic inactivation (PDI) is a new type of non-thermal sterilization technology that combines visible light with photosensitizers to generate a bioactive effect against foodborne pathogenic bacteria. In the present investigation, gelatin (GEL)/chitosan (CS)-based functional films with PDI potency were prepared by incorporating curcumin (Cur) as a photosensitizer. The properties of GEL/CS/Cur (0.025, 0.05, 0.1, 0.2 mmol/L) films were investigated by evaluating the surface morphology, chemical structure, light transmittance, and mechanical properties, as well as the photochemical and thermal stability. The results showed a strong interaction and good compatibility between the molecules present in the GEL/CS/Cur films. The addition of Cur improved different film characteristics, including thickness, mechanical properties, and solubility. More importantly, when Cur was present at a concentration of 0.1 mM, the curcumin-mediated PDI inactivated >4.5 Log CFU/mL (>99.99%) of Listeria monocytogenes, Escherichia coli, and Shewanella putrefaciens after 70 min (15.96 J/cm2) of irradiation with blue LED (455 ± 5) nm. Moreover, Listeria monocytogenes and Shewanella putrefaciens were completely inactivated after 70 min of light exposure when the Cur concentration was 0.2 mM. In contrast, the highest inactivation effect was observed in Vibrio parahaemolyticus. This study showed that the inclusion of Cur in the biopolymer-based film transport system in combination with photodynamic activation represents a promising option for the preparation of food packaging films.

Photodynamic therapy combined with immunotherapy for an advanced esophageal cancer with an obstruction post metal stent implantation: A case report and literature review

BACKGROUND

Surgery is the main treatment for resectable esophageal cancer but not for advanced esophageal cancer with distant metastasis. PDT is a therapeutic strategy for dysphagia and select unresectable esophageal cancer, with tremendous advantages of minimal invasiveness and organ-preserving treatment modality. PDT prevents tumor progression and growth by inducing vascular injury and local acute inflammatory responses. Immunotherapy, combined with PDT, may contribute to the efficacy of PDT in the treatment of esophageal cancer and reduce the probability of tumor recurrence.

CASE REPORT

A 54-year-old male patient with advanced esophageal cancer was hospitalized in the author's hospital on 20th April 2020, who had been treated with two cycles of chemotherapy at the local hospital but failed. In this case, after metal stent implantation, the patient underwent a remarkable and successful treatment of PDT combined with sintilimab, a PD-1 inhibitor. An additional immune checkpoint inhibitor and chemotherapy offer the opportunity to eliminate residual and invisible tumors. The patient had an excellent prognosis that not only the primary lesion was cured, but also the metastatic lymph nodes were significantly reduced, with no tumor recurrence in the last endoscopic review.

CONCLUSION

PDT in combination with immunotherapy is a promising strategy to eliminate primary and metastatic esophageal cancer by generating local and systemic antitumor responses, especially after interventional esophageal stent implantation for relief of obstruction.

Photodynamic therapy induces human esophageal carcinoma cell pyroptosis by targeting the PKM2/caspase-8/caspase-3/GSDME axis

Photodynamic therapy (PDT) uses a photosensitizer (PS) and visible light to induce cancer cell death. Pyroptosis is a new type of programmed cell death that is associated with the gasdermin protein family. However, the precise mechanism of pyroptosis in PDT-induced suppression of esophageal cancer remains unknown. We demonstrate that PDT can induce gasdermin E (GSDME)-mediated pyroptosis, which is characterized by the formation of pyroptotic blebs in esophageal squamous cell carcinoma (ESCC), which burst and release intracellular contents and pro-inflammatory mediators. Mechanistically, PDT may inhibit pyruvate kinase M2 (PKM2) and consequently, activate caspase-8 and caspase-3, which ultimately releases N-GSDME and triggers pyroptosis in ESCC. Moreover, PDT decreased the efficiency of pyroptosis in the presence of a glycolytic inhibitor. Overall, our results show that PDT induces pyroptosis in ESCC by targeting the PKM2/caspase-8/caspase-3/GSDME axis. This is the first in-depth study of the specific mechanism underlying PKM2-mediated pyroptosis under PDT in ESCC, and potentially has great implications for the clinical application of PDT in ESCC.

The influence of photodynamic therapy on the Warburg effect in esophageal cancer cells

To investigate whether the Warburg effect is a key modulator on the resistance mechanism of photodynamic therapy (PDT). Glycolysis was examined by the test of lactate product and glucose uptake at different post-PDT time points. Cell viability was detected by the CCK-8 assay and cell proliferation was detected by colony formation assay. The expression of glycolysis and related proteins were examined by western blotting. Target gene was silenced by RNAi. In the present study, we assessed the effect of PDT on cancer cell glycolysis. Our team has demonstrated that pyruvate kinase M2 (PKM2), a key speed-limiting enzyme of glycolysis, was significantly overexpressed in patients with esophageal cancer. Our results in the present study showed that PKM2 was downregulated, and lactate product and glucose uptake were inhibited in cells exposed to 5-aminolevulinic acid (5-ALA)-mediated PDT at 4 h after treatment. However, at 24 h after PDT, we observed a substantial increase in PKM2 expression, lactate product, and glucose uptake. Moreover, silencing of PKM2 gene abrogated the upregulatory effect of PDT on glycolysis at late post-PDT period. 2-Deoxy-D-glucose (2-DG) is a recognized chemical inhibitor of glycolysis. The combined treatment of 2-DG and PDT significantly inhibited tumor growth in vitro at 24 h. These results demonstrate that PDT drives the Warburg effect in a time-dependent manner, and PKM2 plays an important role in this progress, which indicated that PKM2 may be a potential molecular target to increase the sensitivity of esophageal cancer cells to PDT.

Nanotechnology-based photoimmunological therapies for cancer

Phototherapy is a non-invasive or minimally invasive therapeutic strategy. Immunotherapy uses different immunological approaches, such as antibodies, vaccines, immunoadjuvants, and cytokines to stimulate the host immune system to fight against diseases. In cancer treatment, phototherapy not only destroys tumor cells, but also induces immunogenic tumor cell death to initiate a systemic anti-tumor immune response. When combined with immunotherapy, the effectiveness of phototherapy can be enhanced. Because of their special physical, chemical, and sometimes immunological properties, nanomaterials have also been used to enhance phototherapy. In this article, we review the recent progress in nanotechnology-based phototherapy, including nano-photothermal therapy, nano-photochemical therapy, and nano-photoimmunological therapy in cancer treatment. Specifically, we focus on the immunological responses induced by nano-phototherapies.

RasGRP3, a Ras guanyl releasing protein 3 that contributes to malignant proliferation and aggressiveness in human esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma (ESCC) is one of the most common cancers worldwide; however, clinical and pathological parameters have limited ability in discriminating between clinically significant and indolent ESCC. Since RasGRP3 transcript levels have prognostic value in discriminating ESCC with different clinical aggressiveness, we decided to investigate its putative oncogenic role in ESCC. We found that RasGRP3 was highly expressed in ESCC cells. Suppression of endogenous RasGRP3 expression in esophageal cell lines reduced Ras-GTP formation as well as AKT phosphorylation. RasGRP3 suppression also inhibited cell invasion and migration and reduced proliferation, demonstrating the importance of RasGRP3 for the transformed phenotype of melanoma cells. Suppression of RasGRP3 expression in these cells inhibited downstream RasGRP3 responses and suppressed cell growth and migration, confirming the functional role of RasGRP3 in the altered behaviour of these cells. This suggests that RasGRP3 may function as a Ras activator in the phosphoinositide signalling pathway and may potentially serve as a new therapeutic target.

Photodynamic therapy versus endoscopic submucosal dissection for management of patients with early esophageal neoplasia: a retrospective study

Background

Photodynamic therapy (PDT) and endoscopic submucosal dissection (ESD) have been proposed as a treatment for early esophageal neoplasia. The objective of this study is to compare between the clinical outcome after ESD and PDT to reach the best management for early esophageal neoplasia.

Methods

All patients undergoing ESD or PDT for early esophageal neoplasia between 2014 and 2015 were eligible for the study. A retrospective analysis for comparison between the results of ESD and PDT was done.

Results

36 patients underwent ESD and Thirty PDT. No significant difference was found between the two groups regarding the demographic or pathologic data. Also, there was no significant difference regarding the length of hospital stay, presence of hydrothorax, fever, and pain. Operative time was significantly longer in ESD than in PDT (72 vs. 8 minutes, P<0.001). In addition, bleeding was significantly lower in ESD than PDT (12 vs. 2, P<0.05). There was a significant difference regarding stricture and cost which were less in ESD (6 vs. 15, P<0.05). However, perforation was much more in ESD (6 vs. 0, P<0.05). There was no significant difference between the two groups regarding the disease free survival (DFS), but it was observed that patients who underwent PDT had more favorable 2-year DFS rates than patients received ESD.

Conclusions

The PDT may be comparable to the ESD. With the exception of esophageal stenosis, PDT could reduce many complications and have longer DFS in comparison with ESD. PDT is feasible for patients with early esophageal neoplasia confined to the mucosal layer without regional lymph nodal or distant metastasis.

Novel zinc phthalocyanine as a promising photosensitizer for photodynamic treatment of esophageal cancer

Photodynamic therapy (PDT) has gathered much attention in the field of cancer treatment and is increasingly used as an alternative solution for esophageal cancer therapy. However, there is a constant need for improving the effectiveness and tolerability of the applied photosensitizers (PS). Here, we propose tetra-triethyleneoxysulfonyl substituted zinc phthalocyanine (ZnPc) as a promising PS for photodynamic treatment of esophageal cancer. ZnPc-induced phototoxicity was studied in two human esophageal cancer cell lines: OE-33 (adenocarcinoma) and Kyse-140 (squamous cell carcinoma). In vitro studies focused on the uptake and intracellular distribution of the novel ZnPc as well as on its growth inhibitory potential, reactive oxygen species (ROS) formation and the induction of apoptosis. The chicken chorioallantoic membrane assay (CAM assay) and studies on native Wistar rats were employed to determine the antineoplastic and antiangiogenic activity of ZnPc-PDT as well as the tolerability and safety of non-photoactivated ZnPc in vivo. ZnPc was taken up by cancer cells in a dose- and time-dependent manner and showed a homogeneous cytoplasmic distribution. Photoactivation of ZnPc-loaded (1-10 µM) cells led to a dose-dependent growth inhibition of esophageal adenocarcinoma and squamous cell carcinoma cells of >90%. The antiproliferative effect was based on ROS-induced cytotoxicity and the induction of mitochondria-driven apoptosis. In vivo studies on esophageal tumor plaques grown on the CAM revealed pronounced antiangiogenic and antineoplastic effects. ZnPc-PDT caused long-lasting changes in the vascular architecture and a marked reduction of tumor feeding blood vessels. Animal studies confirmed the good tolerability and systemic safety of ZnPc, as no changes in immunological, behavioral and organic parameters could be detected upon treatment with the non-photoactivated ZnPc. Our findings show the extraordinary photoactive potential of the novel ZnPc as a photosensitizer for PDT of esophageal cancer.