Inhaled Immunotherapy Administration for Lung Cancer; Efficient? Certainly Possible

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Abstract

Lung cancer is still diagnosed at a late stage in most lung cancer patients. Regarding Non-small Cell lung cancer there are novel therapies such as; tyrosine kinase inhibitors and immunotherapy. Currently we have two immunotherapies that can be used either as first-line treatment or second line treatment; pembrolizumab and nivolumab. A third one is being investigated as a combination of immunotherapy; ipilimumab. Aerosol treatment has been investigated for many diseases not only for the lung, but also for systematic diseases. The design of cups was found the most significant factor in producing significant effects. The comparison of cups reveals the design J as the most capable of reducing the droplets at a minimum size of mass median aerodynamic diameter (MMAD) MMAD=1.99. Drug effect comes second in sequence (F=62.04) showing that nivolumab is the most drastic preparation at low particle sizes (1.89), two drugs share an intermediate particle diameter (pembrolizumab and ipilimumab). In total drugs demonstrate a decreasing droplet size: Ipilimumab>Pembrolizumab> Nivolumab.

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Pulmonary drug delivery. Part II: the role of inhalant delivery devices and drug formulations in therapeutic effectiveness of aerosolized medications.

N R Labiris, M Dolovich (2003)

Research in the area of pulmonary drug delivery has gathered momentum in the last several years, with increased interest in using the lung as a means of delivering drugs systemically. Advances in device technology have led to the development of more efficient delivery systems capable of delivering larger doses and finer particles into the lung. As more efficient pulmonary delivery devices and sophisticated formulations become available, physicians and health professionals will have a choice of a wide variety of device and formulation combinations that will target specific cells or regions of the lung, avoid the lung's clearance mechanisms and be retained within the lung for longer periods. It is now recognized that it is not enough just to have inhalation therapy available for prescribing; physicians and other healthcare providers need a basic understanding of aerosol science, inhaled formulations, delivery devices, and bioequivalence of products to prescribe these therapies optimally.

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Inhaled chemotherapy in lung cancer: future concept of nanomedicine

Paul Zarogoulidis, Ekaterini Chatzaki, Konstantinos Porpodis … (2012)

Regional chemotherapy was first used for lung cancer 30 years ago. Since then, new methods of drug delivery and pharmaceuticals have been investigated in vitro, and in animals and humans. An extensive review of drug delivery systems, pharmaceuticals, patient monitoring, methods of enhancing inhaled drug deposition, safety and efficacy, and also additional applications of inhaled chemotherapy and its advantages and disadvantages are presented. Regional chemotherapy to the lung parenchyma for lung cancer is feasible and efficient. Safety depends on the chemotherapy agent delivered to the lungs and is dose-dependent and time-dependent. Further evaluation is needed to provide data regarding early lung cancer stages, and whether regional chemotherapy can be used as neoadjuvant or adjuvant treatment. Finally, inhaled chemotherapy could one day be administered at home with fewer systemic adverse effects.

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Feasibility and effectiveness of inhaled carboplatin in NSCLC patients.

Maria Mabroudi, Athanasios Zisimopoulos, Helliel Lithoxopoulou … (2012)

Inhaled chemotherapy is under investigation as an alternative therapeutic modality for Non-Small Cell Lung Cancer. 60 NSCLC patients were randomized into 3 groups in this study. 20/60 patients (group A-control group) received I.V. chemotherapy (carboplatin AUC ≈ 5.5 D1); 20/60 (group B) received 2/3 of I.V. predicted carboplatin dose by I.V. infusion and the rest 1/3 as aerosol (jet nebulised D1); and 20/60 (group C) received all the predicted I.V. dose of carboplatin as aerosol in 3 equally divided fractions D1-3. In all patients I.V. docetaxel 100/m(2) was as well administered (D1). Lung functional tests were performed in all groups before chemotherapy in the 3rd and 6th cycles. Group B had a statistically significant increase in survival compared to control group A [275 days (95% CI 249-300) vs. 211 (95% CI 185-236)]. In regard to lung functional tests, a statistically significant decline was observed only in FEV1 of group C in 6 months compared to the initial measurement. Inhaled carboplatin could be given as an alternative root of pulmonary drug delivery in selected patients, but further randomized studies remain to prove whether the inhaled chemotherapy is an efficient and safe treatment modality.

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Journal

Journal ID (nlm-ta): J Cancer

Journal ID (iso-abbrev): J Cancer

Journal ID (publisher-id): jca

Title: Journal of Cancer

Publisher: Ivyspring International Publisher (Sydney )

ISSN (Electronic): 1837-9664

Publication date Collection: 2018

Publication date (Electronic): 2 March 2018

Volume: 9

Issue: 6

Pages: 1121-1126

Affiliations

[1 ]3rd Department of Surgery, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece

[2 ]Pulmonary Department-Oncology Unit, “Theageneio” Cancer Hospital, Thessaloniki, Greece

[3 ]Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China

[4 ]Department of Respiratory Diseases, The Affiliated Jiangning hospital of Nanjing Medical University, Nanjing, China

[5 ]Radiation-Oncology Department, “Theageneio” Cancer Hospital, Thessaloniki, Greece

[6 ]Ear, Nose and Throat Department, “Saint Luke“ Private Hospital, Panorama, Thessaloniki, Greece

[7 ]1 st University Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Alexandroupolis, Alexandroupolis, Greece

[8 ]Anatomy Department, Democritus University of Alexandroupolis, Alexandroupolis, Greece

[9 ]Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece

[10 ]Department of Pharmacology & Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

[11 ]Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany

[12 ]Department of Pathology, Hackensack Meridian Health-Hackensack University Medical Center, NJ, USA

[13 ]Anesthesiology Department, “AHEPA” University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

[14 ]Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, ''Hof'' Clinics, University of Erlangen, Hof, Germany

Author notes

✉ Corresponding author: Konstantinos Sapalidis, 3rd Department of Surgery, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece telephone: 6944706828. Paul Zarogoulidis, M.D, Pulmonary Oncology-Unit, “Theageneio” Cancer Hospital, Thessaloniki, Greece. Mobile: 00306977271974; E-mail: pzarog@ 123456hotmail.com

* contributed equally to this work.

Competing Interests: The authors have declared that no competing interest exists.

Article

Publisher ID: jcav09p1121

DOI: 10.7150/jca.24397

PMC ID: 5868180

SO-VID: 5bb0f718-54f3-4eac-aa67-a93670f16ef7

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This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license ( https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions.

Inhaled Immunotherapy Administration for Lung Cancer; Efficient? Certainly Possible

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Cancer Immunotherapy

Most cited references 21

Pulmonary drug delivery. Part II: the role of inhalant delivery devices and drug formulations in therapeutic effectiveness of aerosolized medications.

Inhaled chemotherapy in lung cancer: future concept of nanomedicine

Feasibility and effectiveness of inhaled carboplatin in NSCLC patients.

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