Cited by 1,262Nanoparticle-Based Drug DeliveryNanoplatforms for cancer theranosticsUltrasound and Hyperthermia Applications

Tumor targeting via EPR: Strategies to enhance patient responses

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Golombek, Susanne K., May, Jan-Niklas, Theek, Benjamin, Appold, Lia, Drude, Natascha, Kiessling, Fabian, Lammers, Twan·2018·Advanced Drug Delivery Reviews

Abstract

The tumor accumulation of nanomedicines relies on the enhanced permeability and retention (EPR) effect. In the last 5-10 years, it has been increasingly recognized that there is a large inter- and intra-individual heterogeneity in EPR-mediated tumor targeting, explaining the heterogeneous outcomes of clinical trials in which nanomedicine formulations have been evaluated. To address this heterogeneity, as in other areas of oncology drug development, we have to move away from a one-size-fits-all tumor targeting approach, towards methods that can be employed to individualize and improve nanomedicine treatments. To this end, efforts have to be invested in better understanding the nature, the complexity and the heterogeneity of the EPR effect, and in establishing systems and strategies to enhance, combine, bypass and image EPR-based tumor targeting. In the present manuscript, we summarize key studies in which these strategies are explored, and we discuss how these approaches can be employed to enhance patient responses.

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Crossref · 10.1016/j.addr.2018.07.007

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  • Around 97% of NPs are delivered to tumors by endothelial cells through an active process of transcytosis instead of passive transport.

    “They showed around 97% of the NPs are delivered to tumors by endothelial cells through an active process of transcytosis instead of passive transport.”

    From Approaches to Improve EPR-Based Drug Delivery for Cancer Therapy and Diagnosis (2023) · cites this paper as [161]

    The Principles of EPR section says nanomedicine accumulation in tumors is mainly based on the EPR effect, contrary to the claim that approximately 97% is delivered by active transcytosis rather than passive transport. The Vascular targeting section discusses transcytosis only as a proposed mechanism for specifically targeted nanocarriers; it gives no 97% figure. Page numbers are unavailable in our copy. (LLM, conf=0.85)

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  • Chan W.C.W et al. demonstrated that inter-endothelial gaps in tumors may not be responsible for the transport of nanodrugs into solid tumors.

    “A recent study by Chan W.C.W et al. demonstrated that inter-endothelial gaps in tumors may not be responsible for the transport of nanodrugs into solid tumors [161].”

    From Approaches to Improve EPR-Based Drug Delivery for Cancer Therapy and Diagnosis (2023) · cites this paper as [161]

    The Introduction (page unavailable) says that wide openings in tumor blood vessels allow nanomedicines to leave the vessels. The Anti-angiogenic therapy section (page unavailable) specifically says that closing gaps between endothelial cells limits drug delivery. Rather than reporting the attributed finding, this source describes those gaps as a route for transport into tumors. (LLM, conf=0.86)

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  • The frequency of gaps on the endothelial lining in tumors is too low to account for NP accumulation in the tumor site, observed by TEM analysis.

    “Contrary to the EPR mechanism, the frequency of the gaps on the endothelial lining in tumors is too low to account for the NP accumulation in the tumor site, which was observed by TEM analysis [161].”

    From Approaches to Improve EPR-Based Drug Delivery for Cancer Therapy and Diagnosis (2023) · cites this paper as [161]

    The Introduction (page unavailable) says abnormally wide tumor-vessel fenestrations allow nanomedicines to leave the bloodstream and, with absent lymphatic drainage, accumulate in tumors. The Principles of EPR section likewise describes vascular leakiness as a basis for tumor targeting. The paper does not report the claimed TEM finding that endothelial gaps are too infrequent to account for accumulation. (LLM, conf=0.83)

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  • Several studies have demonstrated that only 0.1 to 0.2% of the injected dose is efficient against tumor cells and exhibits significant anticancer effects.

    “Several studies have demonstrated that only 0.1 to 0.2% of the injected dose is efficient against tumor cells and exhibits significant anticancer effects [20,123,161].”

    From Approaches to Improve EPR-Based Drug Delivery for Cancer Therapy and Diagnosis (2023) · cites this paper as [161]

    The Introduction says that tumor accumulation of 0.7% of the injected dose may suffice for effective antitumor therapy and patient benefit, and that standard cytostatic compounds typically achieve less. It does not give the claimed 0.1–0.2% range or establish that this specific fraction produces significant anticancer effects. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Defining the dominant mechanism of entry of NPs into tumors may help engineer effective delivery carriers to enhance cancer therapy.

    “Therefore, defining the dominant mechanism of the entry of NPs into tumors may help engineer effective delivery carriers to enhance cancer therapy [161].”

    From Approaches to Improve EPR-Based Drug Delivery for Cancer Therapy and Diagnosis (2023) · cites this paper as [161]

    The Introduction explains how nanoparticles enter tumors through EPR-related vascular permeability, and the Summarizing discussion links better understanding of tumor accumulation to more rational nanomedicine design and improved patient responses. The paper does not specifically say that identifying the dominant mechanism of nanoparticle entry is needed to engineer delivery carriers. (LLM, conf=0.83)

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Research works printed but not linked: 1

  1. [138]Blood-Brain Barrier Opened Non-Invasively With Focused Ultrasound for the First Time Focused Ultrasound Foundation accessed May 11, 2017 (n.d.). https://www.fusfoundation.org/news/129-press-room/1677-blood-brain-barrier-opened-non-invasively-with-focused-ultrasound-for-the-first-time

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Authors
Golombek, S. K., May, J.-N., Theek, B., Appold, L., Drude, N., Kiessling, F., & Lammers, T.
Affiliations
  • Universitätsklinikum Aachen (DE)
  • Utrecht University (NL)
Corresponding author
Lammers, Twan
Venue
Advanced Drug Delivery Reviews
Publisher
Elsevier BV
Published
2018-05
Volume
130
Pages
17-38
ISSN
0169-409X (ISSN-L)
OpenAlex
W2884616676
Cited by
1,262
References
227
Citations by year
2026: 118 · 2025: 115 · 2024: 121 · 2023: 124 · 2022: 200 · 2021: 261 · 2020: 221 · 2019: 93 · 2018: 7
FWCI
9.62
Type
journal article
Language
en
Open access
Locations
  • Advanced Drug Delivery Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • University of Twente Research Information (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • RWTH Publications (RWTH Aachen) (submittedVersion)
  • University of Twente Research Information (submittedVersion, cc-by-nc-nd)
Funders
  • European Research Council (309495, 680882, 813086)
  • German research Foundation (La2937/1-2, SFB/TRR57, SFB1066, GRK2375)
  • European Union
Topics
  • Physical Sciences › Materials Science › Biomaterials › Nanoparticle-Based Drug Delivery
  • Physical Sciences › Engineering › Biomedical Engineering › Nanoplatforms for cancer theranostics
  • Physical Sciences › Engineering › Biomedical Engineering › Ultrasound and Hyperthermia Applications
Keywords
enhanced permeability and retention effect, tumor targeting, nanomedicine, tumor heterogeneity, precision oncology, tumor imaging, tumor accumulation
MeSH terms
Antineoplastic Agents, Humans, Neoplasms, Permeability, Drug Delivery Systems, Nanomedicine

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