Photoimmunotherapy in general surgery: systematic review based on an experimental model of trastuzumab-resistant HER2+ breast cancer

Introduction Near-infrared photoimmunotherapy (NIR-PIT) combines the specificity of monoclonal antibodies with the cytotoxic action of light-activated photosensitizers. Upon irradiation, these agents not only induce selective tumor cell death but also enable cell visualization through fluorescence, positioning PIT as a dual diagnostic and therapeutic strategy in surgical oncology. Materials and Methods Building upon experimental evidence from a trastuzumab-resistant HER2-positive breast cancer model, where the trastuzumab-photosensitizer conjugate effectively inhibited tumor growth via singlet oxygen generation, we conducted a systematic review following PRISMA guidelines. We included preclinical studies relevant to general surgery evaluating PIT alone or in combination with surgical resection. Data were extracted on efficacy, recurrence, toxicity, fluorescence, and histopathology. Results Twenty-four murine studies were included. All demonstrated tumor growth inhibition with PIT. In malignancies such as gastric cancer with peritoneal carcinomatosis, pancreatic adenocarcinoma, colorectal cancer, and breast cancer, the combination with surgery achieved complete responses in up to 85% of treated animals. Several studies confirmed high-contrast fluorescence imaging of tumors. No significant adverse effects were reported. Conclusions PIT offers real-time tumor visualization and selective ablation, representing a promising tool to enhance surgical precision, improve local control, and reduce recurrence in oncologic surgery. Validation in immunocompetent models and translation into clinical trials will be essential to establish its role in general surgical practice.