The role of epidermal growth factor receptor in photodynamic therapy: a review of the literature and proposal for future investigation.

The epidermal growth factor receptor (EGFR) pathway seems to be an important contributor to the antiproliferative response to photodynamic therapy (PDT), in terms of cell death, apoptosis and tumour destruction. We reviewed all preclinical investigations in the scientific literature on the role of the EGFR pathway in PDT. A systematic search of Medline-indexed references up to March 2010 using the recommended strategies for Medline information retrieval and identifying relevant studies from systematic reviews, revealed 16 full articles that were exhaustively analysed. EGFR inhibition/degradation appeared to be a major effect of PDT in all investigations. PDT was found to result in a time-dependent reduction of EGFR expression, inhibition of tyrosine phosphorylation and induction of apoptosis during the regression of tumours. Within the time period of the PDT reaction, normal and malignant cells lose their responsiveness to EGF. The ERK1/2 and EGFR-PI3K-Akt pathways seem to be involved in cellular survival after PDT. Pharmacotherapy and immunotherapy to block EGFR activity combined with PDT seem to be very effective in reducing malignant tumours in vivo. The effect of PDT is associated with inactivation of the EGFR pathway, but biochemical and cellular phenomena are important and scarcely investigated. EGFR inhibitors and PDT act synergistically, and this is highly relevant for clinical use.