Opportunities in combinational chemo-immunotherapy for breast cancer using nanotechnology: an emerging landscape

ABSTRACT

Introduction

Breast carcinoma (BC) is one of the most frequent causes of cancer-related death among women, which is due to the poor response to conventional therapy. There are several complications associated with monotherapy for cancer, such as cytotoxicity to normal cells, multidrug resistance (MDR), side effects, and limited applications. To overcome these challenges, a combination of chemotherapy and immunotherapy (monoclonal antibodies, anticancer vaccines, checkpoint inhibitors, and cytokines) has been introduced. Drug delivery systems (DDSs) based on nanotechnology have more applications in BC treatment owing to their controlled and targeted drug release with lower toxicity and reduced adverse drug effects. Several nanocarriers, such as liposomes, nanoparticles, dendrimers, and micelles, have been used for the effective delivery of drugs.

Areas covered

This article presents opportunities and challenges in BC treatment, the rationale for cancer immunotherapy, and several combinational approaches with their applications for BC treatment.

Expert opinion

Nanotechnology can be used for the early prognosis and cure of BC. Several novel and targeted DDSs have been developed to enhance the efficacy of anticancer drugs. This article aims to understand new strategies for the treatment of BC and the appropriate design of nanocarriers used as a combinational DDS.

KEYWORDS:

• Anticancer vaccines
• breast carcinoma
• checkpoint blocker
• cytokines
• liposomes
• monoclonal antibodies

Article highlights

• Breast carcinoma is considered first in most malignant tumors in females.

• A novel, targeted, stimuli-sensitive drug delivery system provides a strategy for enhancing the therapeutic effects of anticancer drugs. Nanotechnology-based systems have been fabricated to reduce the adverse effects of drugs and to increase the therapeutic effects of existing drugs.

• Various nanocarriers have been employed for the effective treatment of BC, such as liposomes, solid lipid nanoparticles, polymeric nanoparticles, dendrimers, micelles, and magnetic nanoparticles.

• The main strategy of immuno-oncology, influenced by the advancement of antigen presentation by dendritic cells (DCs), is to enhance the production of tumor-specific cytotoxic T lymphocytes (CTLs) and suppress inhibitory immune mechanisms.

• Immunotherapy is used to target several obstacles that abolish the endogenous anticancer immune responses. They include monoclonal antibodies (mAbs), cancer vaccines, checkpoint blockers, and immunomodulators such as cytokines.

This box summarizes key points contained in the article.

Abbreviations

1. BC = Breast carcinoma

2. MDR = Multidrug resistance

3. mAb = Monoclonal antibody

4. ER = Estrogen receptor

5. PR = Progesterone receptor

6. TNBC =Triple-negative breast cancer

7. EPR = Enhancing permeability and retention effect

8. FDA= Food and Drug Administration

9. siRNA = Small interfering ribonucleic acid

10. miRNA = Micro ribonucleic acid

11. DC = Dendritic cell

12. CTL= Cytotoxic T lymphocyte

13. CNS = Central nervous system

14. BBB = Blood–brain barrier

15. HA = Hyaluronic acid

16. TIME = Tumor immune microenvironment

17. DTX = Docetaxel

18. EMT = Epithelial-mesenchymal transition

19. PMN = Pre-metastatic niche

20. TAA = Tumor-associated immunogenic tumor antigen

21. P-gp = P-glycoprotein

22. CPP = Cell-penetrating peptide

23. NC = Nanocomplex

24. CR = Complete response

25. PR = Partial response

26. PFS = Progression-free survival

27. CT = Clinical trial

Declarations of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.