Porfimer Sodium (Photofrin) - Uses, Dose, Side effects, MOA, Warnings

Porfimer Sodium (Photofrin) is used in photodynamic therapy because of its photosensitizing properties. It is used in the ablation of Barrett's esophagus and esophageal cancer.

Porfimer Sodium Uses:

Barrett esophagus dysplasia (photodynamic therapy):
- Porfirmer is used as an ablative material for high-grade dysplasia in condition like Barrett's esophagus (in patients who cannot undergo esophagectomy)
Endobronchial cancer (photodynamic therapy):
- Micro invasive endobronchial non-small cell lung cancer uses Porfirmer as the main ingredient in patients for whom surgery or radiotherapy is not indicated.
- It can also be used in palliative procedures like reducing the obstruction caused by NSLC.
Esophageal cancer (photodynamic therapy):
- In esophageal carcinomas porfirmer can also be used in palliation of complete or partial obstruction in patients who are not eligible for Nd: YAG laser therapy.

Porfimer Sodium (Photofrin) Dose in Adults

Porfimer Sodium (Photofrin) Dose in the treatment of Esophageal cancer or endobronchial non-small cell lung cancer (photodynamic therapy):

IV: It is given as 2 mg/kg followed by endoscopic exposure to the appropriate laser light and debridement. Repeat course can be given by at least a 4-week interval. the interval is necessary for the healing process to ensue.
3 courses can be administered maximally.

Porfimer Sodium (Photofrin) Dose in the treatment of Barrett esophagus dysplasia (photodynamic therapy):

IV: It is given as 2 mg/kg followed by endoscopic exposure to the appropriate laser light. The same dose can be repeated at least 90-day intervals which are necessary for the healing process. Up to 3 courses can be given.

Use in Children:

Not indicated.

Pregnancy Risk Factor C

Negative events have been observed in animal reproductive studies.

Porfimer use during breastfeeding:

It's possible that it is secreted in breastmilk, but this has not been proven.
It is important to conduct a clinical assessment before administering this medicine.
This will ensure that the benefits outweigh any potential adverse effects on pregnant women and infants.

Dose in Kidney disease:

No dose adjustment has been provided by Porfirmer manufacturers although prolonged treatment in presence of kidney disease is not advisable.

Dose in Liver disease:

No dose adjustments required in liver diseases however caution must be taken into account when administering this medicine for prolonged periods of time.

Common Side Effects of Porfimer Sodium (Photofrin):

Cardiovascular:
- Chest Pain
Central Nervous System:
- Confusion
- Pain
- Insomnia
Dermatologic:
- Skin Photosensitivity
Gastrointestinal:
- Esophageal Stenosis
- Nausea
- Constipation
- Abdominal Pain
- Vomiting
- Dysphagia
Hematologic & Oncologic:
- Anemia
Neuromuscular & Skeletal:
- Back Pain
Respiratory:
- Pleural Effusion
- Dyspnea
- Bronchial Obstruction
- Bronchial Plugs
- Pneumonia
- Hemoptysis
- Cough
- Bronchoconstriction
- Pharyngitis
Miscellaneous:
- Fever
- Serous Drainage

Less Common Side Effects Of Porfimer Sodium (Photofrin):

Cardiovascular:
- Atrial Fibrillation
- Hypotension
- Peripheral Edema
- Cardiac Failure
- Hypertension
- Tachycardia
- Edema
- Substernal Pain
- Angina Pectoris
- Bradycardia
- Myocardial Infarction
- Pulmonary Embolism
- Sick Sinus Syndrome
- Supraventricular Tachycardia
- Thrombosis
Central Nervous System:
- Anxiety
- Voice Disorder
Endocrine & Metabolic:
- Weight Loss
- Dehydration
Gastrointestinal:
- Anorexia
- Disease Of Esophagus
- Hematemesis
- Tracheoesophageal Fistula
- Dyspepsia
- Diarrhea
- Eructation
- Esophagitis
- Melena
- Esophageal Perforation
- Gastric Ulcer
- Intestinal Obstruction
- Peritonitis
Genitourinary:
- Urinary Tract Infection
Hematologic & Oncologic:
- Tumor Hemorrhage
- Pulmonary Hemorrhage
Hepatic:
- Jaundice
Infection:
- Candidiasis
- Abscess
Neuromuscular & Skeletal:
- Weakness
Ophthalmic:
- Diplopia
- Eye Pain
- Photophobia
- Visual Disturbance
Respiratory:
- Bronchitis
- Respiratory Insufficiency
- Airway Obstruction
- Bronchospasm
- Pneumonitis
- Pulmonary Edema
- Respiratory Failure
- Stridor
Miscellaneous:
- Ulcer
- Postoperative Complication

Contraindications to Porfimer Sodium (Photofrin):

Porphyria can be a contraindication to porfirmer.
Patients with a pre-existing bronchoesophageal, tracheoesophageal, or tracheoesophageal fistula are advised to avoid photodynamic therapy (PDT). It can worsen the existing conditions.
A tumor that escapes into a major blood vessel can increase the chance of an internal major bleed.
Endobronchial CA can cause severe acute respiratory distress.
Gastric or esophageal varices, esophageal ulcers larger than 10mm in diameter

Canadian labeling: Additional contraindications not in US labeling

If you have hypersensitivity to porphyrins, it is a contraindication to using porfirmer.
Patients with papillary bladder carcinoma who have had prior total bladder radiation are not advised to undergo photodynamic therapy.
For patients with bladder cancers that are stage greater than 1 (T1), which is invasive.

Warnings and precautions

Obstructing the airway:
- Porfirmer treatment can cause inflammation that may lead to bronchial obstruction.
- Patients with tumors of the bronchi should be cautious, especially if they are located in the main airway. This can lead to acute obstruction.
- Necrosis and mucositis can cause debris accumulation and obstruction.
- Between laser therapy and debridement of respiratory distress, patients should be closely monitored.
- It can be necessary to perform urgent bronchoscopy in order to remove any secretions or debris.
Chest pain:
- Inflammatory responses can cause chest pain.
Esophageal strictures:
- Within 6 months of starting treatment, esophageal tightening can occur.
- Multiple interventions may be required to treat the strictures.
- Nodule pretreatment and re-treatment in the same area can increase the risk.
Extravasation:
- Avoid extravasation.
- Protect the area affected by extravasation from sunlight
- No antidote exists to combat this.
Gastroesophageal fistula/perforation:
- It is possible to have serious and even fatal gastrointestinal necrosis or ulceration, which could lead to perforations.
- Patients with esophageal cancers that have eroded into the trachea and bronchial trees are at high risk of developing fistulas should not be used.
- The treatment of a tracheoesophageal, broncho-esophageal, or bronchoesophageal fistula should be avoided.
Hemorrhage:
- Patients who have esophageal varices, tumors or tumors that have eroding pulmonary blood vessels are at greater risk of major bleeding.
- This can lead to massive pulmonary hemoptysis (FMH), which can be fatal.
- Additional risk factors include cavitating tumors and large tumors that are centrally located, as well as extensive tumors that are not in the bronchus.
Ocular photosensitivity
- Also, photophobia can be seen.
- Patients should wear sunglasses with a minimum white light transmittance (4%) for at least 30 days.
Photosensitivity
- Patients who are exposed to intense indoor or direct sunlight are more susceptible to photosensitivity reactions.
- UV sunscreens older than 10 years have not been shown to protect against photosensitivity reactions due to visible light.
- Photosensitivity can last from 1 to 3 months.
- Encourage indoor exposure (helps to gradually activate residual porfimer).
- Before resuming protective measures, patients should be informed about residual photophobia.
- Slowly re-exposure to sunlight should be done. For example, expose a small area of skin (not the face) for 10 minutes.
- If photosensitivity does not occur after 24 hours, then one can gradually resume outdoor activities.
- However, if photosensitivity does occur, wait two weeks before retesting.
Thromboembolism
- Patients with advanced cancer, heart disease, and prolonged immobilization are more likely to experience thromboembolic events.
Barrett's esophagus
- Patients with Barrett's esophagus should be monitored closely (e.g., endoscopic biopsy every 3 to 4 months until 4 consecutive negative results of high-grade dysplasia.
- Then, more follow-up according to clinical judgement.
- It is not known if photodynamic therapy has long-term effects on Barrett's esophagus patients.
- Photodynamic therapy for Barrett's esophageal disease can cause esophageal strictures. Sometimes, esophageal dilation may also be necessary.
Varieties for the esophageal/gastric system:
- Due to the high risk of major bleeding, this product is not suitable for patients suffering from esophageal and gastric varices.
Hepatic impairment
- Hepatic impairment may prolong elimination, which could lead to toxicities that are higher.
- Patients with mild-to severe hepatic impairment may experience increased photosensitivity beyond 90 days.
Renal impairment
- In cases of renal impairment, elimination may take longer and toxicities can occur.
- Patients with severe renal impairment may experience increased photosensitivity beyond 90 days.

Monitoring Parameters:

None mentioned.

How to administer Porfimer Sodium (Photofrin)?

IV:

Give slow IV injection over 3 to 5 minutes.
Avoid extravasation (if extravasation occurs, protect the area from light and sunlight).
Due to the risk for photosensitivity reactions, wear rubber gloves and eye protection and avoid skin and eye contact during administration.
If prolonged exposure occurs, protect from bright light.
Spilled material should be wiped with a wet cloth and contaminated material should be disposed of adequately.

Mechanism of action of Porfimer Sodium (Photofrin):

The cytotoxic effects of Porfimer are dependent on oxygen and light.
After administration, the drug is retained in neoplastic tissues.
The drug can be exposed to laser light at wavelengths greater than 630 nm, which results in the formation of oxygen-free radicals.
It is possible for thromboxane to be released, causing vascular occlusion or ischemic necrosis.

Protein binding, plasma: