title: Overcoming physiologic barriers to cancer treatment by molecularly targeting the tumor microenvironment.
abstract: It is widely recognized that the vasculature of the tumor is inadequate to meet the demands of the growing mass. The malformed vasculature is at least in part responsible for regions of the tumor that are hypoxic, acidotic, and exposed to increased interstitial fluid pressure. These unique aspects of the tumor microenvironment have been shown to act as barriers to conventional chemotherapy or radiation-based therapies. It now seems that while the vasculature initiates these tumor-specific conditions, the cells within the tumor respond to these stresses and add to the unique solid tumor physiology. Gene expression changes have been reported in the tumor for vascular endothelial growth factor, carbonic anhydrase IX, and pyruvate dehydrogenase kinase 1. The activity of these gene products then influences the tumor physiology through alterations in vascular permeability and interstitial fluid pressure, extracellular acidosis, and mitochondrial oxygen consumption and hypoxia, respectively. Novel molecular strategies designed to interfere with the activities of these gene products are being devised as ways to overcome the physiologic barriers in the tumor to standard anticancer therapies.
authors.affiliation: Division of Radiation and Cancer Biology, Department of Radiation Oncology, Stanford University School of Medicine, CCSR-South, Room 1245, Stanford, CA 94305-5152, USA.
authors.forename: Rob
authors.initials: R
authors.lastname: Cairns
authors.forename: Ioanna
authors.initials: I
authors.lastname: Papandreou
authors.forename: Nicholas
authors.initials: N
authors.lastname: Denko
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002199:Capillary Permeability; D052138:Genes, Neoplasm / Q000187:drug effects*; D006801:Humans; D009363:Neoplasm Proteins / Q000235:genetics; D009369:Neoplasms / Q000098:blood supply / Q000628:therapy*; D009389:Neovascularization, Pathologic / Q000235:genetics
chemical_list: D000970:Antineoplastic Agents; D009363:Neoplasm Proteins