What Is Involved?

First, the porfimer sodium is given intravenously (IV or into a vein). It travels through the bloodstream to be absorbed by all cells in the body, including both normal and cancer cells. The normal cells get rid of most of the porfimer sodium over a couple of days. However, much of the drug remains in cancer cells and in cells of the skin.

Porfimer sodium alone does not destroy cancer cells. It must be activated by light. About 2 or 3 days are allowed to pass after the drug is given so that normal cells have a chance to get rid of it. The doctor then directs a laser light at the area of cancer cells using a very thin glass strand called a fiber optic. To treat esophageal cancer or Barrett’s esophagus, the fiber optic is passed down the throat through a thin, flexible tube called an endoscope. For lung cancer treatment, the fiber optic is passed through a bronchoscope, an endoscope specially designed to reach the lung.

The laser used is a low-power light so it does not burn, and there is little or no pain during the procedure. The light is applied for 5 to 40 minutes, depending on the size of the tumor that is being treated. Any dead tissue remaining in the treated area is then removed during endoscopy or bronchoscopy 4 to 5 days later. The treatment can be repeated if necessary.

Who Should Not Get Treated With Porfimer Sodium?

Porfimer sodium is not recommended for those with:

• a disease of the blood called acute intermittent porphyria
• an allergy to porphyrins
• a fistula (abnormal opening) between the windpipe and esophagus or between a bronchus and esophagus
• a tumor eroding into a major blood vessel

Possible Side Effects

The major possible side effects from porfimer sodium are photosensitivity reactions and swelling in the treated area (which may cause pain or trouble swallowing or breathing). Other, minor side effects are possible as well.

Photosensitivity reactions: As soon as porfimer sodium is injected into the bloodstream, it begins to collect in the cells of the body. Some of it will remain there for several weeks. The skin and eyes are especially sensitive to light during this time. If exposed to sunlight or other forms of bright light, the skin can quickly become swollen, sunburned, and blistered. It takes only a few minutes for a reaction to occur, so it is important to protect the eyes and skin from exposure. Once you receive an injection of porfimer sodium, you should take precautions (see below) to prevent reactions for at least 30 days. Sensitivity to light can last as long as 3 months, but the length of time is different with each person. If you have a reaction, call your doctor right away.

You should try to avoid bright lights and direct sunlight, but you do not have stay in dark rooms. Some indoor light is important because it will help to slowly break down the drug in your skin. As a result, your skin will become less photosensitive over time. Ask your doctor when and how you should test your skin for photosensitivity. This is usually done no sooner than 30 days after you receive the injection.

Taking these precautions can help prevent a photosensitivity reaction:

• Before going to your doctor's office or hospital for treatment, close the shades and curtains on windows in your home. Be sure windows and skylights are fully covered.

• Bring dark sunglasses, gloves, a wide brimmed hat, pants, socks, shoes, and a long-sleeve shirt to wear after your appointment. Clothing should be light in color and the fabric should be tightly woven.

• Do not count on sunscreen to protect you. Sunscreens only protect against ultraviolet light, so they will not prevent a photosensitivity reaction.

• For at least 30 days after you receive the injection, limit your time outdoors, especially when the sun’s rays are strongest (between about 11AM and 2PM). When you do go outside, cover as much skin as possible, even on cloudy days and while you are in the car.

• Try to do most daily errands after sundown.

• Do not expose your skin to reading lamps, exam lamps (such as those used in a dentist’s office), or "helmet"-type hair dryers (such as those often found in beauty salons). If you use a hand-held hair dryer, use a low heat setting to avoid burns to your scalp.

Swelling: Swelling in the area being treated can lead to pain in the chest or back. If the esophagus is being treated, it may lead to narrowing (stricture) of the esophagus, which could cause problems swallowing. Treatment of the lung could lead to trouble breathing. If you note any of these problems, let your doctor know right away.

Other possible side effects: These depend on the area of the body that is being treated. If the esophagus is being treated, possible side effects include nausea, vomiting, fever, dehydration, headache, hiccups, and fluid building up around the lungs. In people being treated for lung cancer, possible side effects include shortness of breath, coughing up blood, fever, pneumonia, and bronchitis.

If you are being treated with porfimer sodium, ask your doctor which side effects to report right away and what phone number to call if you have side effects after regular office hours.

Revised: 03/20/2007