title: Nanomedicine strategies to overcome the pathophysiological barriers of pancreatic cancer.
abstract: Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer- related deaths. PDAC remains one of the most difficult-to-treat cancers, owing to its unique pathobiological features: a nearly impenetrable desmoplastic stroma, and hypovascular and hypoperfused tumour vessels render most treatment options largely ineffective. Progress in understanding the pathobiology and signalling pathways involved in disease progression is helping researchers to develop novel ways to fight PDAC, including improved nanotechnology-based drug-delivery platforms that have the potential to overcome the biological barriers of the disease that underlie persistent drug resistance. So-called 'nanomedicine' strategies have the potential to enable targeting of the Hedgehog-signalling pathway, the autophagy pathway, and specific RAS-mutant phenotypes, among other pathological processes of the disease. These novel therapies, alone or in combination with agents designed to disrupt the pathobiological barriers of the disease, could result in superior treatments, with increased efficacy and reduced off-target toxicities compared with the current standard-of-care regimens. By overcoming drug-delivery challenges, advances can be made in the treatment of PDAC, a disease for which limited improvement in overall survival has been achieved over the past several decades. We discuss the approaches to nanomedicine that have been pursued to date and those that are the focus of ongoing research, and outline their potential, as well as the key challenges that must be overcome.
authors.affiliation: Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland 21702, USA.
authors.forename: Pavan P
authors.initials: PP
authors.lastname: Adiseshaiah
authors.affiliation: Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland 21702, USA.
authors.forename: Rachael M
authors.initials: RM
authors.lastname: Crist
authors.affiliation: Office of the Director, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: Sara S
authors.initials: SS
authors.lastname: Hook
authors.affiliation: Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland 21702, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: McNeil
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001343:Autophagy / Q000502:physiology; D021441:Carcinoma, Pancreatic Ductal / Q000098:blood supply / Q000188:drug therapy* / Q000209:etiology; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016503:Drug Delivery Systems; D005109:Extracellular Matrix / Q000187:drug effects; D053823:Hedgehog Proteins / Q000378:metabolism; D006801:Humans; D050997:Nanomedicine / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000188:drug therapy* / Q000209:etiology; D019869:Phosphatidylinositol 3-Kinases / Q000378:metabolism; D020794:Receptor Protein-Tyrosine Kinases / Q000378:metabolism; D015398:Signal Transduction / Q000502:physiology; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D053823:Hedgehog Proteins; D003841:Deoxycytidine; D019869:Phosphatidylinositol 3-Kinases; D020794:Receptor Protein-Tyrosine Kinases; D000093542:Gemcitabine