In an operating room at Froedtert & the Medical College of Wisconsin, lung tumors are now literally lighting up for surgeons. Milwaukee specialists have started using Cytalux, an imaging drug that makes tiny lung tumors glow during operations so doctors can find and remove lesions that routine inspection might miss. This week, assistant professor Mallory Hunt used the FDA-approved agent to track down a pea-sized nodule and perform a limited resection that preserved healthy lung tissue. It is the first reported use of the drug for lung surgery in the Milwaukee area and could expand options for patients once considered too high risk for an operation.
Surgeons get 'eyes' on tiny tumors
Hunt described Cytalux to local reporters as “an agent that allows us to eliminate cancer cells during surgery,” according to CBS 58. Patients receive the drug before an operation, where it binds to folate receptors that are often overexpressed on tumors and, under special near infrared filters on a robotic camera, causes the targeted tissue to glow, most often a bright neon green. Hunt told CBS 58 the fluorescent signal helped her pick up lesions that were too small or too deep to find with standard visual or tactile checks alone.
FDA backing and trial data
The U.S. Food and Drug Administration expanded Cytalux's label to include detection of lung lesions after a randomized multicenter trial showed the agent helped surgeons identify additional cancerous tissue that standard inspection missed, according to the FDA. In the pivotal study the agency cites, about 24% of patients had the index lesion or extra cancerous tissue picked up under fluorescence that was not seen with normal visual or manual inspection. Regulators emphasize that Cytalux is used as an adjunct imaging tool and list known risks, including infusion related reactions and the chance of false positive or false negative findings.
Patient case shows small tumors can be found
One of Hunt’s recent patients, Milwaukee resident Mark Unak, had a lung nodule that grew from roughly 3 millimeters to 9 millimeters on follow up scans. With Cytalux, the team was able to locate and remove the tiny lesion while limiting how much lung they took out, the report says. “This is a drug that’s allowing the doctor to go in and get a specimen that could possibly have a clean margin the first time,” Unak told CBS 58. Hunt said the technology has also allowed surgeons to offer less invasive, lung sparing procedures to patients who were previously viewed as too high risk for traditional surgery.
What patients should know
Doctors stress that Cytalux improves visualization during surgery but does not treat cancer on its own. The FDA warns of potential infusion related reactions such as nausea, vomiting and flushing, and advises patients to avoid folate supplements within 48 hours before receiving a dose, per the FDA. The agency also notes that the agent may cause fetal harm if given during pregnancy and that images can still yield false negatives or false positives. The move into wider clinical use follows years of research and development at major centers, including work at Penn Medicine, that supported the expanded indication.
Local impact and next steps
Froedtert’s adoption of Cytalux could broaden treatment choices across the health system’s thoracic surgery program, particularly for patients with small or hard to find nodules, according to surgeons there. Hunt estimated she operates on about 15 to 20 people a week and sees a potential role for the imaging tool in many of those cases. As the region’s academic medical center, Froedtert is positioned both to offer the technology and to monitor outcomes over time. Patients who want to know whether they might be candidates can contact Froedtert & the Medical College of Wisconsin’s thoracic surgery program for referrals and more information, the hospital’s website notes.
