title: Clinical experience with drug delivery systems as tools to decrease the toxicity of anticancer chemotherapeutic agents.
abstract: The toxicity of chemotherapeutic agents, resulting from their low pharmacological index, introduces considerable discomfort and risk to cancer patients. Among several strategies to reduce the toxicity of chemotherapeutic agents, targeted drug delivery is the most promising one. Areas covered: Liposomes, micelles, albumin-based, polymeric, dendritic and lipid core nanoparticles have been used as carriers to concentrate anticancer drugs in neoplastic tissues, and clinical studies of those preparations are reviewed. In most clinical studies, drug delivery systems reduced drug toxicity. Lipid core nanoparticles (LDE) that bind to cell lipoprotein receptors have the ability to concentrate in neoplastic tissues and were the first artificial non-liposomal system shown in in vivo studies to possess targeting properties. The toxicity reduction achieved by LDE as vehicle of carmustine, etoposide and paclitaxel was singularly strong. Expert opinion: The reduced toxicity offered by drug delivery systems has expanded treatment population that may benefit from chemotherapy including feeble, overtreated and elderly patients that would otherwise be offered palliative therapy. Drug delivery systems may either prolong the duration of treatments or allow increases in drug dose.
authors.affiliation: a Heart Institute of the Medical School Hospital , University of São Paulo , São Paulo , Brazil.|b Faculty of Pharmaceutical Sciences , University of São Paulo , São Paulo , Brazil.
authors.forename: Raul C
authors.initials: RC
authors.lastname: Maranhão
authors.affiliation: a Heart Institute of the Medical School Hospital , University of São Paulo , São Paulo , Brazil.|b Faculty of Pharmaceutical Sciences , University of São Paulo , São Paulo , Brazil.
authors.forename: Carolina G
authors.initials: CG
authors.lastname: Vital
authors.affiliation: a Heart Institute of the Medical School Hospital , University of São Paulo , São Paulo , Brazil.|b Faculty of Pharmaceutical Sciences , University of São Paulo , São Paulo , Brazil.
authors.forename: Thauany M
authors.initials: TM
authors.lastname: Tavoni
authors.affiliation: a Heart Institute of the Medical School Hospital , University of São Paulo , São Paulo , Brazil.
authors.forename: Silvia R
authors.initials: SR
authors.lastname: Graziani
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use / Q000633:toxicity; D016503:Drug Delivery Systems; D006801:Humans; D008055:Lipids / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity; D008081:Liposomes; D053758:Nanoparticles / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity
chemical_list: D000970:Antineoplastic Agents; D008055:Lipids; D008081:Liposomes
keywords: Cancer treatment; LDL receptors and cancer; chemotherapy toxicity; drug targeting; lipid core particles; liposomes; nanoemulsions; polymeric nanoparticles