Spokane pulmonologist Dr. Gregory Loewen says a combination laser and drug treatment that he helped develop is showing promise in curing early-stage lung cancer.


Loewen says he has used the treatment, called photodynamic therapy, successfully on two patients here to kill and remove tumors and on several other patients for reducing airway obstruction caused by inoperable tumors.


He says he expects his referrals to rise, based on those positive outcomes, and would like to see the therapy used more frequently in concert with testing of patients at high risk of developing lung cancer.


Loewen was part of a research team at the Roswell Park Cancer Institute, in Buffalo, N.Y., that helped get the combination treatment approved by the Food and Drug Administration in 1998 for treatment of non-small-cell lung cancers. He says he used the technique in a research setting at the institute for 15 years while teaching there.


Some 200,000 new lung-cancer cases strike in the U.S. each year, and though doctors are now using the procedure, he believes it is underused, Loewen says.


Thousand of patients could benefit, from the treatment, he says. Why dont we try to defeat lung cancer early?


Loewen recently was named program director for the thoracic section of the Providence Cancer Center here. He says he was attracted to Spokane in part because Sacred Heart is committed to building a strong cancer program here.


Loewen, who grew up in Walla Walla, joined Spokane Respiratory Consultants PS, where he still practices, when he sought to move back to the Northwest to be near his then-fianc about a year ago. They married two months ago.


The photodynamic therapy treatment takes about a week, Loewen says. First, the patient is injected with Photofrin, a drug that carries the toxic singlet form of oxygenthe kind people take antioxidants to protect themselves from, Loewen says.


Healthy cells quickly rid themselves of the drug, but cancerous cells cant expel it, Loewen says. Two days after the injection, the patient is brought in for laser treatment, using a thin lighted tube called a bronchoscope, Loewen says.


The bronchoscope is inserted through the patients nose or mouth down into the bronchial tube that contains the tumor, and a small quartz fiber is inserted through the tube into the tumor, or is placed beside the tumor if the tumor is flat.


Laser light similar to the strength of that in a grocery store bar code scanner is emitted, Loewen says. The light and the drug produce a photochemical reaction, causing the photosynthesizing drug to release the oxygen, which kills the cancer cells in the treatment area.


A couple of days later, the patient returns for another bronchoscopy, in which the doctor excises the dead cancerous tissue, although not with the laser, and removes it from the body.


The use of photodynamic therapy is limited to tumors in the main airways in the lungs, Loewen says, as direct exposure to the laser light is necessary to activate the drug. On its own, Photofrin is inert, Loewen says.


The drug, though, does have a major side effectextreme light sensitivity, such that the patient is handed a care package of protective clothing that includes a wide-brimmed fishermans hat, black gloves, and dark sunglasses to wear when leaving the hospital after being injected with Photofrin.


After treatment, the patient must remain out of direct sunlight for four to six weeks or risk a sunburn-like skin reaction. Second-generation photosynthesizing drugs are being tested in an effort to reduce that effect, which Loewen describes as a nuisance, but manageable.


Two distinct uses


The primary use of the therapy thus far has been to relieve pain for inoperable lung cancer patients.


Loewen says about one-third of all non-small-cell cancers in the lungs create tumors that protrude from the lung tissue to partially obstruct one of the two main bronchial tubes. Even a small obstruction in one of those bronchial tubes can cause a patient significant pain and complications, such as a collapsed lung.


For patients with larger tumors of that type, photodynamic therapy is a second or third line of treatment, when surgery and radiation either cant be used due to other complicating factors like advanced emphysema, or when those treatments already have been tried, Loewen says.


In such cases, photodynamic therapy can restore the function of a collapsed lung, and relieve pain for those patients, as well as slow the progress of the disease.


Theres a lot we can do to help these people, Loewen says.


In those cases, however, the treatment is not considered a cure, because the obstruction is just part of a larger tumor that has grown in the lung and that cant be reached with the laser.


Loewen says he has found that another use for the treatment is promising as a cure. In some early stage cancers or for lung cancer survivors who have a relapse, a new lesion can be removed entirely if it is visible on the lining of the bronchial tube. Such lesions, when viewed with a bronchoscope, look like flat, red areas on the bronchial tube.


Loewen and his colleagues at Roswell published an article discussing the potential for the combination treatments curative use in a medical journal called Lasers in Surgery and Medicine last year.


Lung cancer survivors are among those who can benefit from the therapy because they have a 3 percent per year rate of relapse, Loewen says.


After 10 years, 30 percent of those patients will have developed another cancer. Loewen asserts that monitoring such high-risk patients potentially can offer them a longer life expectancy if new cancerous lesions are discovered in their earliest stages.


Slow to catch on


Despite the promise of photodynamic therapy to alleviate pain and perhaps cure some patients, the technique still isnt being used extensively around the country. Axcan Pharma, a subsidiary of Montreal-based Axcan Scandipharm Inc. that manufactures Photofrin, says Loewen is the only Spokane physician who uses the therapy.


It says about 50 hospitals around the country account for 80 percent of the sales of the drug, which Loewen says has annual sales of about $14 million.


Loewen says the adoption of the therapy by the medical community has been slow in part because its a combination of a drug and a procedure, which has inhibited the marketing of it.


Additionally, Loewen says he believes the medical community has been slow to embrace the idea of early detection for lung cancer, in part due to studies funded by the National Cancer Institute in the 1970s that concluded early detection wasnt practical.


New imaging and bronchoscopy techniques have changed that, he says. Lung cancer risk factors can be identified readily, and people at high risk can be monitored to increase early detection and improve outcomes, he says.


Along with the lung cancer applications, photodynamic therapy recently was approved by the FDA for other uses, including treatment of certain skin cancers and for treatment of one kind of macular degeneration, in which vision is impaired by scarring from burst blood vessels on the center of the retina.


Loewen says one of the keys to good outcomes with any type of cancer is early detection, and lung cancer is no exception.


He says he would like to see photodynamic therapy used more often in conjunction with increased monitoring of other patients at high risk for developing cancer.


Contact Jeanne Gustafson at (509) 344-1264 or via e-mail at jeanneg@spokanejournal.com.