A revolutionary laser treatment could kill off breast cancer in 15 minutes - and with no need for a mastectomy. No wonder doctors are excited
- Photodynamic therapy is approved to treat four cancers, including skin, lung
- Scientists are testing its efficacy in curing breast cancer
- A laser beam is directed into the tumour, made light-sensitive by a drug, killing the cancer
- If successful, it works without affecting the surrounding healthy tissue
- Some say, though, that the evidence PDT works is 'patchy'
Pioneering patient: Fiona is taking part in a trial of photodynamic therapy
Fiona Fisher was diagnosed with breast cancer this summer and was astounded when her doctors suggested that their first move should be to try to kill the tumour by blasting it with a laser for 15 minutes.
This involved injecting a drug into the tumour to make it sensitive to light. Then, via a needle, they shone an intensive laser beam into the cancer to kill it.
'The whole thing was less invasive than the biopsy that I had to confirm the diagnosis of cancer,' says Fiona, 57, a self-employed management consultant living in Primrose Hill, North London.
While this may sound like the kind of story that has cancer doctors in despair at the gullibility of patients who fall for an expensive and unproven treatment, in fact Fiona is at the centre of one of the most carefully considered and authoritative - as well as potentially revolutionary - experiments in the field of breast cancer.
Just eight weeks ago, Fiona became concerned when the top of her left breast felt thickened and granular. Within a fortnight, she'd become one of the first four patients - there will be 30 in all - being given photodynamic therapy (PDT) in the initial phase of a new trial at the Royal Free Hospital in North London.
Photodynamic therapy was first pioneered as a cancer therapy in the UK 25 years ago, and is now approved by the National Institute for Health and Care Excellence (NICE) as treatment of four cancers: the skin (though not melanoma), early or late cancers of head and neck, lung and oesophageal.
'It's an extraordinary treatment that cuts the cost and time involved, and means patients don't have to undergo other treatments that cause very unpleasant side-effects,' says David Longman, founder of the charity Killing Cancer.
'It's also quick; patients and their families know within a short period of time whether the cancer has been destroyed.' Until recently, the treatment had a major drawback: it stayed in the body for weeks, causing patients to be ultra-sensitive to ordinary light, and be unable to leave the house for weeks after treatment.
What's made the current breast cancer trial possible is the introduction of new drugs that leave the body within 48 hours.
As with all the trial participants, Fiona spent 48 hours after her treatment in a darkened room in a private ward of the Royal Free Hospital. 'It was a wonderful and quite luxurious rest,' she recalls.
Experts predict that photodynamic therapy could eventually make the non-invasive treatment the norm for some types of breast cancer. In other words, a cure without the need for surgery.
Light show: After a drug is injected into the tumour to make it sensitive to light, an intensive laser is beamed into the cancer to kill it
'The beauty of this technology is that, if successful, it works without affecting the surrounding healthy tissue, leaving the breasts completely intact,' says Professor Mohammed Keshtgar, a breast cancer surgeon at the Royal Free who is leading the new research.
This trial of photodynamic therapy is the first to test it for primary (newly diagnosed) breast cancer.
The initial stage of the trial is 'a dose-escalating study' to discover the most effective combination dose of drugs and light, with the patients receiving an MRI scan before and after the treatment to gauge its impact on the tumour.
As the treatment is unproven, the women in the trial have had to agree to undergo a full mastectomy afterwards: the trial cannot put the participants at any risk of their cancer returning. But the tissue removed during mastectomies will be analysed to check the effects of the photodynamic therapy.
Which is why, just a couple of days after emerging from the Royal Free's private wing, Fiona returned to the NHS operating theatre at the hospital to have a full mastectomy, as well as a reconstruction of her left breast. And next week she will embark on chemotherapy and radiotherapy, followed by a course of hormone tablets.
'The beauty of this technology is that, if successful, it works without affecting the surrounding healthy tissue, leaving the breasts completely intact.'
'I may be getting no benefit myself, but to know my contribution might change the experience of breast cancer for women in the future makes it worthwhile,' she says.
The Royal Free team is determined to discover the truth about photodynamic therapy in cancer treatment. While other centres, including University College London, have studied PDT, there's been a lack of properly funded, authoritative research. And Cancer Research UK also insists that the evidence is 'too patchy'.
What's more, NICE's approval of photodynamic therapy for skin and oesophageal cancer comes with warnings that the evidence in favour of it is 'of poor quality', and that hospitals should consider this when deciding whether to use it.
It's hoped the new trial will convince more people in the field to try PDT.
'Surgeons are largely comfortable with PDT because they are used to using equipment such as lasers,' says Dr Mahendra Deonarain, honorary reader in antibody technology and therapeutics at Imperial College London, and chief science officer at Photobiotics, a company pioneering more targeted ways of delivering the treatment.
'But cancer treatment today is decided by a multi-disciplinary team. It's difficult for these different specialties to communicate the benefits well enough to bring about a dramatic change in treatment.'
The first phase of the three-stage Royal Free study is recruiting patients, but this should be completed within two years.
The next phase will involve recruiting a larger group of women who have been diagnosed with breast cancer but refuse a mastectomy for personal reasons, or are unfit for surgery.
Foregoing mastectomy: Fiona Fisher had a full mastectomy after taking part in the trial, but if it's proven to be effective, those undergoing photodynamic therapy will not need surgery
'We will be asking them to undergo PDT without any further treatment - and then follow their progress over several months to discover whether the age of the patient and the sort and grade of the tumour affects the efficacy of the treatment - and compare the results with women treated conventionally,' says Professor Keshtgar.
'It's essential that we leave no room for doubt about the outcome of this trial.
'If it works, we want the treatment to be fully approved by NICE and to be widely available for breast cancer patients.'
Dr Keyvan Moghissi, clinical director of the Yorkshire Laser Centre in Goole, East Yorkshire, says it's important that patients' expectations of the therapy are realistic.
'It's hugely effective for the right cancers, but it doesn't work for every patient,' says Dr Moghissi, who, as editor of the journal Photodiagnosis and Photodynamic Therapy, has overseen the publication of scores of papers on the treatment.
More importantly, at the centre in East Yorkshire, he has been using PDT as a cancer treatment for over 20 years, but says he usually recommends the treatment for only around one in ten of patients.
'It doesn't work for many cancers such as leukaemia, and it's only successful when the tumour is very localised,' he says. 'What's more, often the best results are achieved when PDT is used alongside the conventional therapies: surgery, chemotherapy and radiotherapy.'
Yet such a view may change with the new study. So far, four women have received photodynamic therapy and MRI - and in at least some of these it seems the cancer has cleared completely.
While Professor Keshtgar gives little away, he admits 'the whole team is feeling very encouraged' and that, aged 50, he hopes to see the introduction of photodynamic therapy for newly diagnosed breast cancer 'within my career lifetime'. But there is a long journey ahead.
'The purpose of the research at the moment is to get the dose right, not treat the tumour. But we are noting whether the tumour is visible in the second, post-treatment MRI scan and in the mastectomy tissue under the microscope. And there are hopeful signs.'
