Najafi Masoud, Majidpoor Jamal, Toolee Heidar, Mortezaee Keywan
Medical Technology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran.
J Biochem Mol Toxicol. 2021 Nov;35(11):e22900. doi: 10.1002/jbt.22900. Epub 2021 Aug 31.
Solid cancers comprise a large number of new cases and deaths from cancer each year globally. There are a number of strategies for addressing tumors raised from solid organs including surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy, combinational therapy, and stem cell and extracellular vesicle (EV) therapy. Surgery, radiotherapy, and chemotherapy are the dominant cures, but are not always effective, in which even in a localized tumor there is a possibility of tumor relapse after surgical resection. Over half of the cancer patients will receive radiotherapy as a part of their therapeutic schedule. Radiotherapy can cause an abscopal response for boosting the activity of the immune system outside the local field of radiation, but it may also cause an unwanted bystander effect, predisposing nonradiated cells into carcinogenesis. In the context of immunotherapy, immune checkpoint inhibition is known as the standard-of-care, but the major concern is in regard with cold cancers that show low responses to such therapy. Stem-cell therapy can be used to send prodrugs toward the tumor area; this strategy, however, has its own predicaments, such as unwanted attraction toward the other sites including healthy tissues and its instability. A substitute to such therapy and quite a novel strategy is to use EVs, by virtue of their stability and potential to cross biological barriers and long-term storage of contents. Combination therapy is the current focus. Despite advances in the field, there are still unmet concerns in the area of effective cancer therapy, raising challenges and opportunities for future investigations.
实体癌每年在全球范围内导致大量新增癌症病例和死亡。针对实体器官产生的肿瘤有多种治疗策略,包括手术、化疗、放疗、靶向治疗、免疫治疗、联合治疗以及干细胞和细胞外囊泡(EV)治疗。手术、放疗和化疗是主要的治疗方法,但并非总是有效,即使是局部肿瘤,手术切除后也有可能复发。超过一半的癌症患者会在治疗方案中接受放疗。放疗可引发远隔效应,增强局部放疗区域外的免疫系统活性,但也可能产生不良的旁观者效应,使未受辐射的细胞易发生癌变。在免疫治疗方面,免疫检查点抑制是标准治疗方法,但主要问题在于对这种治疗反应较低的“冷肿瘤”。干细胞疗法可用于将前体药物输送至肿瘤区域;然而,这种策略有其自身的困境,比如对包括健康组织在内的其他部位产生不必要的吸引以及其不稳定性。一种替代疗法且相当新颖的策略是使用细胞外囊泡,这得益于其稳定性、穿越生物屏障的潜力以及内容物的长期储存能力。联合治疗是当前的重点。尽管该领域取得了进展,但在有效的癌症治疗领域仍存在未解决的问题,为未来的研究带来了挑战和机遇。