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Nanomedicines have been designed and developed to deliver anticancer drugs or exert anticancer therapy more selectively to tumor sites. Recent investigations have gone beyond delivering drugs to tumor tissues or cells, but to intracellular compartments for amplifying therapy efficacy. Mitochondria are attractive targets for cancer treatment due to their important functions for cells and close relationships to tumor occurrence and metastasis. Accordingly, multifunctional nanoplatforms have been constructed for cancer therapy with the modification of a variety of mitochondriotropic ligands, to trigger the mitochondria-mediated apoptosis of tumor cells. On this basis, various cancer therapeutic modalities based on mitochondria-targeted nanomedicines are developed by strategies of damaging mitochondria DNA (mtDNA), increasing reactive oxygen species (ROS), disturbing respiratory chain and redox balance. Herein, in this review, we highlight mitochondria-targeted cancer therapies enabled by nanoplatforms including chemotherapy, photothermal therapy (PTT), photodynamic therapy (PDT), chemodynamic therapy (CDT), sonodynamic therapy (SDT), radiodynamic therapy (RDT) and combined immunotherapy, and discussed the ongoing challenges.
RESUMO
RESUMEN: La mucositis oral (MO) es la reacción secundaria aguda más frecuente en la cavidad oral y tracto gastrointestinal en pacientes oncológicos sometidos a quimioterapia o radioterapia de cabeza y cuello que incide negativamente en la calidad de vida del paciente. Su tratamiento requiere de un manejo multidisciplinario con el objetivo de minimizar la incidencia y severidad de esta patología. El desconocimiento parcial respecto de su etiopatogenia imposibilita la realización de protocolos para el manejo de esta complicación. Si bien existe evidencia científica respecto a las alternativas de prevención y tratamiento, éstas dependen de la evaluación individual que haga el clínico con cada paciente. A continuación, se presenta una revisión bibliográfica actualizada de la literatura científica publicada y se discuten aquellos aspectos más relevantes en torno a la prevención y tratamiento de la mucositis oral.
ABSTRACT: Oral mucositis (OM) is the most common acute secondary reaction in the oral cavity and gastrointestinal tract in cancer patients undergoing chemotherapy or radiotherapy to the head and neck, which adversely affects the patient's quality of life even at the risk of death. This requires multidisciplinary knowledge and management in order to minimize the incidence and severity of this pathology. The partial lack of knowledge regarding its etiopathogenesis makes it impossible to establish standardized guidelines for the management of this complication. Although there is scientific evidence regarding prevention and treatment alternatives, these depend on the individual evaluation of each patient and the clinical scenario in which they are presented. An updated review of the published scientific literature is presented below and those aspects most relevant to the prevention and treatment of oral mucositis are discussed.
RESUMO
BACKGROUND: There are several treatment modalities for unresectable neuroendocrine tumors. Traditionally, the aim of these treatments has been to reduce the tumor load; referred to as objective response (OR). Less emphasis has been put on inducing the tumors to stop growing without a reduction in total tumor load; termed as stable disease (SD). We wanted to investigate whether achieving OR compared to obtaining SD predicted a longer time to progression (TTP) in patients with neuroendocrine tumors (WHO Grade 1 and 2) treated with peptide receptor radionuclide therapy, chemotherapy or molecular targeted therapy. METHODS: Patients treated with either peptide receptor radionuclide therapy (PRRT) with 177Lutetium-DOTA-octreotate, the chemotherapy combination streptozotocin/5-fluorouracil or everolimus were retrospectively assessed to evaluate the effect of the treatments on disease progression. We analyzed the TTP for patients for each treatment modality and compared the TTP between those who achieved OR and those who achieved SD. RESULTS: Altogether 56 patients treated with PRRT, 32 treated with streptozotocin/5-fluorouracil and 52 treated with everolimus were included in the analyses. The median TTP for those treated with PRRT and achieving OR was 31 months, the TTP for those achieving SD was 43 months (p = 0,2). For patients treated with streptozotocin/5-fluorouracil the results were: OR: 18 months, SD: 23 months (p = 0,9) and for those treated with everolimus; OR: 9 months, SD: 20 months (p = 0,5), respectively. We found no differences between patients achieving OR compared to SD regarding age, sex, stage, primary tumor location, Ki-67% or ongoing treatment with somatostatin analogues. CONCLUSIONS: We found no treatment benefit with regard to TTP for our patients that experienced OR compared to those who achieved SD.
