Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.
Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA.
Adv Drug Deliv Rev. 2024 Jul;210:115331. doi: 10.1016/j.addr.2024.115331. Epub 2024 May 8.
Improving surgical resection outcomes for locally aggressive tumors is key to inducing durable locoregional disease control and preventing progression to metastatic disease. Macroscopically complete resection of the tumor is the standard of care for many cancers, including breast, ovarian, lung, sarcoma, and mesothelioma. Advancements in cancer diagnostics are increasing the number of surgically eligible cases through early detection. Thus, a unique opportunity arises to improve patient outcomes with decreased recurrence rates via intraoperative delivery treatments using local drug delivery strategies after the tumor has been resected. Of the current systemic treatments (e.g., chemotherapy, targeted therapies, and immunotherapies), immunotherapies are the latest approach to offer significant benefits. Intraoperative strategies benefit from direct access to the tumor microenvironment which improves drug uptake to the tumor and simultaneously minimizes the risk of drug entering healthy tissues thereby resulting in fewer or less toxic adverse events. We review the current state of immunotherapy development and discuss the opportunities that intraoperative treatment provides. We conclude by summarizing progress in current research, identifying areas for exploration, and discussing future prospects in sustained remission.
提高局部侵袭性肿瘤的手术切除效果是诱导持久的局部区域疾病控制和预防转移疾病进展的关键。对于许多癌症，包括乳腺癌、卵巢癌、肺癌、肉瘤和间皮瘤，肿瘤的宏观完全切除是标准的治疗方法。癌症诊断技术的进步通过早期检测增加了手术适应证病例的数量。因此，通过在肿瘤切除后使用局部药物递送策略在术中递送治疗，为改善患者预后、降低复发率提供了独特的机会。在目前的全身治疗方法（如化疗、靶向治疗和免疫疗法）中，免疫疗法是提供显著获益的最新方法。术中策略受益于直接进入肿瘤微环境，从而提高了药物向肿瘤的摄取，并同时最大限度地降低了药物进入健康组织的风险，从而导致更少或毒性更小的不良事件。我们回顾了免疫疗法发展的现状，并讨论了术中治疗提供的机会。最后，我们总结了当前研究的进展，确定了探索的领域，并讨论了持续缓解的未来前景。
