Padeliporfin VTP Using Robotic Assisted Bronchoscopy in Peripheral Lung Cancer

Prior treatment

• Prior exposure to VTP or PDT treatments
• Receiving any other investigational treatment
• Patient has had major surgery within the last 4 weeks.

Other illness

• Patient has a centrally located lung lesion, as defined by RTOG within 2 cm of the proximal bronchial tree, or within 2 cm of other major mediastinal structure (aorta, heart, trachea, pericardium, superior vena cava, pulmonary artery, esophagus, vertebra's body or spinal canal).
• Patient has a lung cancer lesion \>2cm in diameter, for the expansion cohort lesion \>2-3 cm
• Patient has cytologic or histologic evidence of nodal disease
• Patient has a cancer diagnosis with active disease requiring further cancer therapy.
• Patient has porphyria or hypersensitivity to padeliporfin or porphyrin-like compounds or to any of its excipients.

Lab values

• Co-morbidities:
  • Baseline hypoxia with O2 saturation \<92% on 2L NC or more of oxygen
  • New York Heart Association (NYHA) stage III/IV heart failure
  • Unstable coronary artery disease or MI within the last 6 months
  • Uncontrollable clinically serious arrhythmia
  • Decompensated/clinically worsening interstitial lung disease or obstructive lung disease.
  • Unstable cerebrovascular or peripheral vascular disease
  • Inability to stop anticoagulation or anti-platelet therapy peri-procedure
  • Evidence of clinically active infection requiring systemic (any route) antibiotic therapy. All prior infections must have resolved following optimal therapy.
  • Patient has any acute or chronic condition assessed as clinically significant by Investigator which may preclude bronchoscopy procedure
  • History of medical or psychiatric disease which, in the view of the investigator, would preclude safe treatment or acceptable study compliance
  • Known severe pulmonary hypertension (mean pulmonary arterial pressure ≥ 50 mmHg)

Other

• Patient has a lung lesion located less than 1 cm from the pleura or fissure
• Tumor invades major vessels
• Pregnant or breastfeeding women

• Age ≥18
• Patients with primary lung lesions who are at high risk for primary lung cancer.
  • 2.1.Biopsy with intraoperative confirmation of malignancy using on-site cytology will be used as final inclusion prior to study treatment.
• All patients will be approved by a multi-disciplinary team (thoracic surgery, interventional pulmonology, medical oncology and radiation oncology) as appropriate for bronchoscopic VTP prior to surgical resection.
• Tumor size targeted for VTP treatment ≤ 2 cm (Part A) and \<3cm (Part B), based on CT scan, including solid or semi-solid tumors.
• EBUS mediastinal staging performed intraoperative prior to VTP treatment with rapid on-site evaluation negative for nodal involvement of malignancy.
• Tumor is ≥ 2cm from the central bronchial tree (distal 2 cm of the trachea, carina, and named major lobar bronchi up to their first bifurcation) (Timmerman, 2018).
• Lung lesion is not contiguous with and ≥ 1 cm from the pleura/fissures.
• Patient is eligible to undergo bronchoscopy under general anesthesia.
• Tumor is accessible for Padeliporfin VTP treatment via robotic bronchoscopy
• ECOG performance score 0-2
• Estimated life expectancy of ≥3 months
• Adequate organ system function
• Negative serum pregnancy test