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Shaha S, Rodrigues D, Mitragotri S. Locoregional drug delivery for cancer therapy: Preclinical progress and clinical translation. J Control Release 2024; 367:737-767. [PMID: 38325716 DOI: 10.1016/j.jconrel.2024.01.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
Systemic drug delivery is the current clinically preferred route for cancer therapy. However, challenges associated with tumor localization and off-tumor toxic effects limit the clinical effectiveness of this route. Locoregional drug delivery is an emerging viable alternative to systemic therapies. With the improvement in real-time imaging technologies and tools for direct access to tumor lesions, the clinical applicability of locoregional drug delivery is becoming more prominent. Theoretically, locoregional treatments can bypass challenges faced by systemic drug delivery. Preclinically, locoregional delivery of drugs has demonstrated enhanced therapeutic efficacy with limited off-target effects while still yielding an abscopal effect. Clinically, an array of locoregional strategies is under investigation for the delivery of drugs ranging in target and size. Locoregional tumor treatment strategies can be classified into two main categories: 1) direct drug infusion via injection or implanted port and 2) extended drug elution via injected or implanted depot. The number of studies investigating locoregional drug delivery strategies for cancer treatment is rising exponentially, in both preclinical and clinical settings, with some approaches approved for clinical use. Here, we highlight key preclinical advances and the clinical relevance of such locoregional delivery strategies in the treatment of cancer. Furthermore, we critically analyze 949 clinical trials involving locoregional drug delivery and discuss emerging trends.
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Affiliation(s)
- Suyog Shaha
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA; Wyss Institute for Biologically Inspired Engineering, Boston, MA 02115, USA
| | - Danika Rodrigues
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA; Wyss Institute for Biologically Inspired Engineering, Boston, MA 02115, USA
| | - Samir Mitragotri
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA; Wyss Institute for Biologically Inspired Engineering, Boston, MA 02115, USA.
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Abstract
Non-muscle-invasive bladder cancer (NMIBC), the most prevalent type of bladder cancer, accounts for ~75% of bladder cancer diagnoses. This disease has a 50% risk of recurrence and 20% risk of progression within 5 years, despite the use of intravesical adjuvant treatments (such as BCG or mitomycin C) that are recommended by clinical guidelines. Intravesical device-assisted therapies, such as radiofrequency-induced thermochemotherapeutic effect (RITE), conductive hyperthermic chemotherapy, and electromotive drug administration (EMDA), have shown promising efficacy. These device-assisted treatments are an attractive alternative to BCG, as issues with supply have been a problem in some countries. RITE might be an effective treatment option for some patients who have experienced BCG failure and are not candidates for radical cystectomy. Data from trials using EMDA suggest that it is effective in high-risk disease but requires further validation, and results of randomized trials are eagerly awaited for conductive hyperthermic chemotherapy. Considerable heterogeneity in patient cohorts, treatment sessions, use of maintenance regimens, and single-arm study design makes it difficult to draw solid conclusions, although randomized controlled trials have been reported for RITE and EMDA.
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van Valenberg FJP, Strauss-Ayali D, Agmon-Gerstein Y, Friedman A, Arentsen HC, Schaafsma HE, Witjes JA, Oosterwijk E. Assessment of the efficacy of repeated instillations of mitomycin C mixed with a thermosensitive hydrogel in an orthotopic rat bladder cancer model. Ther Adv Urol 2018; 10:213-221. [PMID: 30034540 PMCID: PMC6048623 DOI: 10.1177/1756287218762064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/02/2018] [Indexed: 11/25/2022] Open
Abstract
Background: We investigated a thermoreversible hydrogel that is highly viscous at body
temperature, while fluid-like at a low temperature, thus aiming for a slow
and prolonged intravesical drug release. Our study purposed to assess
antitumor efficacy of mitomycin C (MMC) mixed with hydrogel in an orthotopic
rat bladder cancer model. Methods: Bladders of female Fischer F344 rats were grafted with 1.5 × 106
AY-27 urothelial carcinoma cells. On day 5, tumor presence was assessed by
cystoscopy and rats were divided into six groups (five treatment, one
control, n = 10/group). Intravesical treatments (0.5 mg or
1 mg MMC-H2O or MMC-hydrogel, or 2 mg MMC-hydrogel) were
administered on days 5, 8 and 11. Rats were sacrificed at day 14 and
bladders were evaluated. Results: Rats with tumor at cystoscopy (47/60) were evaluated for efficacy. At
necropsy, all control animals (8/8) had tumors. No microscopic tumors were
present in the 0.5 mg and 1 mg MMC-hydrogel groups compared with 2/8 and 1/8
rats in the 0.5 mg and 1 mg MMC-H2O groups (p =
0.47 and p = 1.00, respectively). Greater toxicity was seen in animals treated with MMC-hydrogel compared with
MMC-H2O, as demonstrated by lower body weights at necropsy
(p = 0.000) and a tendency for more severe clinical
signs in the 1 and 2 mg MMC-hydrogel groups. Rats that died prematurely
received 1 mg (4/10) or 2 mg (9/10) of MMC-hydrogel. Conclusions: Under the current model conditions it is unclear whether instillation of
MMC-hydrogel is more effective than MMC-H2O. Nonetheless, the
observed difference in toxicity, acting as a surrogate marker for systemic
MMC exposure in the MMC-hydrogel-treated rats, supports the prolonged drug
release mechanism of the hydrogel.
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Affiliation(s)
- F Johannes P van Valenberg
- Department of Urology, Radboud University Medical Center, Geert Grooteplein 26-28 (267), PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | | | | | | | | | - H Ewout Schaafsma
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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Re: Sustained-Release Formulation of Mitomycin C to the Upper Urinary Tract Using a Thermosensitive Polymer: A Preclinical Study. J Urol 2017; 198:38. [DOI: 10.1016/j.juro.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Donin NM, Strauss-Ayali D, Agmon-Gerstein Y, Malchi N, Lenis AT, Holden S, Pantuck AJ, Belldegrun AS, Chamie K. Serial retrograde instillations of sustained release formulation of mitomycin C to the upper urinary tract of the Yorkshire swine using a thermosensitive polymer: Safety and feasibility. Urol Oncol 2017; 35:272-278. [PMID: 28065395 DOI: 10.1016/j.urolonc.2016.11.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/11/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND MitoGel is a novel drug formulation intended for the treatment of upper tract urothelial cancer with proven feasibility and safety in an animal model. OBJECTIVE To evaluate the feasibility, safety, toxicokinetics, and histologic changes associated with serial retrograde MitoGel instillations to the upper urinary tract in a swine model. DESIGN, SETTING, AND PARTICIPANTS Overall, 27 Yorkshire swine underwent 6 once-weekly unilateral retrograde instillations of MitoGel. Doses of 14, 28, or 56-mg mitomycin C (respective concentrations of 2, 4, and 8mg/ml with 9 animals per group) were evaluated. Additionally, 6 animals received sterile water as a procedure control, and 9 received gel alone (without mitomycin C), as a vehicle control. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Blood and urine samples were collected for determination of MMC toxicokinetics and for hematology, biochemistry, coagulation, and urinalysis throughout the study. Two-thirds of the cohort were euthanized 24 hours after final instillation, and one-third was euthanized 1 month after final instillation. Necropsy was performed to evaluate the histologic effects of treatments. RESULTS AND LIMITATIONS All animals received all 6 doses of agents per protocol. No mortality, clinical adverse events, or meaningful changes in hematology, chemistry, coagulation, or urinalysis were attributable to MitoGel, RTGel alone, or water instillations. Peak plasma levels of MMC were 2 orders of magnitude less than known toxicity thresholds. MitoGel-related dose-dependent microscopic findings were seen in the treated kidneys and ureters, but were of limited severity, lacked associated clinical adverse findings, and decreased over time. CONCLUSIONS Serial retrograde instillations of MitoGel to the pyelocaliceal system were technically feasible, and produced no observable adverse clinical, laboratory, or histologic effects.
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Affiliation(s)
- Nicholas M Donin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | | | | | | | - Andrew T Lenis
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Stuart Holden
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Allan J Pantuck
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA
| | - Arie S Belldegrun
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA
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Donin NM, Duarte S, Lenis AT, Caliliw R, Torres C, Smithson A, Strauss-Ayali D, Agmon-Gerstein Y, Malchi N, Said J, Raman SS, Holden S, Pantuck A, Belldegrun AS, Chamie K. Sustained-release Formulation of Mitomycin C to the Upper Urinary Tract Using a Thermosensitive Polymer: A Preclinical Study. Urology 2016; 99:270-277. [PMID: 27720772 DOI: 10.1016/j.urology.2016.09.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/22/2016] [Accepted: 09/30/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the safety and feasibility of single and serial instillations of MitoGel into the upper urinary tract using a preclinical swine animal model. MitoGel is a novel sustained release formulation of mitomycin C (MMC) based on RTGel, a proprietary thermosensitive hydrogel technology. MitoGel is liquid at cold temperatures and solidifies to gel state at body temperature. It is intended as a treatment for upper tract urothelial carcinoma, given its ability to provide sustained release of MMC in the upper urinary tract. MATERIALS AND METHODS We utilized 23 pigs in a 3-phase design. All animals underwent bilateral nephrostomy tube placement. During phase 1, 3 animals underwent antegrade RTGel instillation, imaging, and euthanasia within 12 hours. In phase 2, 10 pigs underwent single antegrade instillation, unilateral nephrectomy 3 days following instillation, and contralateral nephrectomy and euthanasia 30 days following instillation. During phase 3, 10 animals underwent 6 instillations over 3 weeks, followed by bilateral nephrectomy and necropsy 30 days postinstillation. MitoGel (2 mg/mL and 4 mg/mL), aqueous MMC (2 mg/mL and 4 mg/mL), and RTGel alone were evaluated. RESULTS MitoGel remained visible within the pelvicalyceal system on fluoroscopic and computed tomography imaging for 4-6 hours. MMC plasma levels were well within acceptable safety thresholds. There was no evidence of urinary obstruction, acute kidney injury, sepsis, or myelosuppression. Histologic changes in the urinary system were mild and transient. CONCLUSION Antegrade MitoGel delivery to the pelvicalyceal system of Yorkshire swine is feasible and safe. Further evaluation of MitoGel in human clinical trials is warranted.
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Affiliation(s)
- Nicholas M Donin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
| | - Sandra Duarte
- Division of Laboratory and Animal Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Andrew T Lenis
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Randy Caliliw
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Cristobal Torres
- Division of Laboratory and Animal Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Anthony Smithson
- Division of Laboratory and Animal Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | | | | | - Jonathan Said
- Department of Pathology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Steven S Raman
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Stuart Holden
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Allan Pantuck
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA
| | - Arie S Belldegrun
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA
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