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      Thirty Years of Cancer Nanomedicine: Success, Frustration, and Hope

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          Abstract

          Starting with the enhanced permeability and retention (EPR) effect discovery, nanomedicine has gained a crucial role in cancer treatment. The advances in the field have led to the approval of nanodrugs with improved safety profile and still inspire the ongoing investigations. However, several restrictions, such as high manufacturing costs, technical challenges, and effectiveness below expectations, raised skeptical opinions within the scientific community about the clinical relevance of nanomedicine. In this review, we aim to give an overall vision of the current hurdles encountered by nanotherapeutics along with their design, development, and translation, and we offer a prospective view on possible strategies to overcome such limitations.

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          Most cited references118

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          Analysis of nanoparticle delivery to tumours

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            A new concept for macromolecular therapeutics in cancer chemotherapy: mechanism of tumoritropic accumulation of proteins and the antitumor agent smancs.

            We previously found that a polymer conjugated to the anticancer protein neocarzinostatin, named smancs, accumulated more in tumor tissues than did neocarzinostatin. To determine the general mechanism of this tumoritropic accumulation of smancs and other proteins, we used radioactive (51Cr-labeled) proteins of various molecular sizes (Mr 12,000 to 160,000) and other properties. In addition, we used dye-complexed serum albumin to visualize the accumulation in tumors of tumor-bearing mice. Many proteins progressively accumulated in the tumor tissues of these mice, and a ratio of the protein concentration in the tumor to that in the blood of 5 was obtained within 19 to 72 h. A large protein like immunoglobulin G required a longer time to reach this value of 5. The protein concentration ratio in the tumor to that in the blood of neither 1 nor 5 was achieved with neocarzinostatin, a representative of a small protein (Mr 12,000) in all time. We speculate that the tumoritropic accumulation of these proteins resulted because of the hypervasculature, an enhanced permeability to even macromolecules, and little recovery through either blood vessels or lymphatic vessels. This accumulation of macromolecules in the tumor was also found after i.v. injection of an albumin-dye complex (Mr 69,000), as well as after injection into normal and tumor tissues. The complex was retained only by tumor tissue for prolonged periods. There was little lymphatic recovery of macromolecules from tumor tissue. The present finding is of potential value in macromolecular tumor therapeutics and diagnosis.
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              Progress and challenges towards targeted delivery of cancer therapeutics

              Targeted delivery approaches for cancer therapeutics have shown a steep rise over the past few decades. However, compared to the plethora of successful pre-clinical studies, only 15 passively targeted nanocarriers (NCs) have been approved for clinical use and none of the actively targeted NCs have advanced past clinical trials. Herein, we review the principles behind targeted delivery approaches to determine potential reasons for their limited clinical translation and success. We propose criteria and considerations that must be taken into account for the development of novel actively targeted NCs. We also highlight the possible directions for the development of successful tumor targeting strategies.
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                Author and article information

                Journal
                Cancers (Basel)
                Cancers (Basel)
                cancers
                Cancers
                MDPI
                2072-6694
                25 November 2019
                December 2019
                : 11
                : 12
                : 1855
                Affiliations
                [1 ]Department of Biotecnology and Bioscience, University of Milano-Bicocca, piazza della Scienza 2, 20126 Milano, Italy; lucia.salvioni@ 123456unimib.it (L.S.); maria.rizzuto@ 123456unimib.it (M.A.R.); jessica.bertolini@ 123456unimib.it (J.A.B.); miriam.colombo@ 123456unimib.it (M.C.)
                [2 ]Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; l.pandolfi@ 123456smatteo.pv.it
                [3 ]Nanomedicine Laboratory, ICS Maugeri, via S. Maugeri 10, 27100 Pavia, Italy
                Author notes
                [†]

                These authors contributed equally to this paper.

                Author information
                https://orcid.org/0000-0003-4577-9575
                Article
                cancers-11-01855
                10.3390/cancers11121855
                6966668
                31769416
                11059bc4-f672-4af7-8a68-572f30276195
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 31 October 2019
                : 22 November 2019
                Categories
                Review

                cancer nanomedicine,epr effect,tumor microenvironment,nanoparticles,nano–bio interactions,clinical translation

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