Fluorescent Imaging Technology Expedites Thoracic Surgery in Lung Cancer

CancerNetwork® spoke with Colleen Gaughan, MD, a thoracic surgeon and chief of surgery at AdventHealth Celebration, about the advantages that pafolacianine (Cytalux) provides over other lung cancer imaging technologies.

Gaughan began by expressing a benefit observed with intravenous infusion prior to surgery over alternative forms of imaging, particularly for smaller lung nodules. She further explained that previous methods included matching the CT scan with the operative field or enlisting an interventional pulmonologist or a radiologist to conduct a navigational bronchoscopy or wire localization, respectively. Gaughan noted that previous methods for conducting imaging in tandem with surgery resulted in lengthier, more costly procedures that presented logistical complications.

By contrast, Gaughan highlighted the pre-operative administration of pafolacianine, which enables a normal flow of surgery without presenting disruptions. She expressed that by using the agent in conjunction with an infrared camera, surgery can be conducted efficiently even as tumors are simultaneously imaged.

Data from the phase 3 ELUCIDATE trial found that at least 1 clinically significant event, defined as eliciting a meaningful change in surgical operation, was found in 53% of patients vs a prespecified limit of 10% (P < .0001). Additionally, 38% of patients had at least 1 event within a margin of 10 mm from the resected primary nodule (95% CI, 28.5%-48.3%).

Transcript:

One of the real advantages of using the medication as an [intravenous] infusion prior to surgery is that before we had this available to us, when we were looking for small lung nodules, [we would do] a couple of things. One, is we would study it against the CT scan and go back and forth between what we were seeing in our operative field and looking at the CT scan. Another technique that we use for looking for small lung tumors is have another professional, usually an interventional pulmonologist, do a navigational bronchoscopy and inject dye directly into the tumor. Sometimes, we would even have our radiologists put a wire into the tumor to help us to localize it.

Now, when you are doing those things, it adds time [and expense] to the procedure, and it could make the logistics of scheduling quite complicated. One of the great things about [pafolacianine] is that it is an [intravenous] medication that we give to patients beforehand. There is no additional professional procedure list time that we have to book, and then we can do the exploration in surgery with our near infrared camera, and it does not disrupt the flow of the surgery. Things still happen along the surgeon’s normal schedule and time, but it gives us this additional information that helps us during surgery.

Reference

Sarkaria IS, Martin LW, Rice DC, et al. Pafolacianine for intraoperative molecular imaging of cancer in the lung: the ELUCIDATE trial. J Thorac Cardiovasc Surg. 2023;166(6):e468-e478. doi:10.1016/j.jtcvs.2023.02.025.