Abstract
Simple SummaryHydroxypropyl acrylamide polymer-conjugated pirarubicin (P-THP), an innovative polymer-conjugated anticancer agent, theoretically has highly tumor-specific distribution via the enhanced permeability and retention (EPR) effect. While anthracyclines are extremely important in the treatment of most pediatric solid tumors, P-THP may serve as a less toxic and more effective substitute for conventional anthracyclines in both newly diagnosed and refractory/recurrent pediatric cancers.Most pediatric cancers are highly chemo-sensitive, and cytotoxic chemotherapy has always been the mainstay of treatment. Anthracyclines are highly effective against most types of childhood cancer, such as neuroblastoma, hepatoblastoma, nephroblastoma, rhabdomyosarcoma, Ewing sarcoma, and so forth. However, acute and chronic cardiotoxicity, one of the major disadvantages of anthracycline use, limits their utility and effectiveness. Hydroxypropyl acrylamide polymer-conjugated pirarubicin (P-THP), which targets tumor tissue highly selectively via the enhanced permeability and retention (EPR) effect, and secondarily releases active pirarubicin molecules quickly into the acidic environment surrounding the tumor. Although, the latter rarely occurs in the non-acidic environment surrounding normal tissue. This mechanism has the potential to minimize acute and chronic toxicities, including cardiotoxicity, as well as maximize the efficacy of chemotherapy through synergy with tumor-targeting accumulation of the active molecules and possible dose-escalation. Simply replacing doxorubicin with P-THP in a given regimen can improve outcomes in anthracycline-sensitive pediatric cancers with little risk of adverse effects, such as cardiotoxicity. As cancer is a dynamic disease showing intra-tumoral heterogeneity during its course, continued parallel development of cytotoxic agents and molecular targeting agents is necessary to find potentially more effective treatments.
Highlights
This article is an open access articleThe maximum effectiveness with minimum toxicity describes the ideal anti-cancer drug
As repeatedly stated in this review article, most pediatric cancers are so chemo-sensitive that the role of cytotoxic agents is much more important than in the treatment of adult cancers
Anthracyclines are highly effective for almost all pediatric cancers, and P-THP may be expected to augment their efficacy once the appropriate dosage is confirmed in early-phase clinical trials
Summary
The maximum effectiveness with minimum toxicity describes the ideal anti-cancer drug. Conventional cytotoxic agents, such as alkylating agents and anthracyclines, are still the mainstay of multidisciplinary treatment for pediatric cancers even in the era of precision medicine [2]. In this regard, improving the drug-delivery system (DDS). Hydroxypropyl methacrylate (HPMA) polymer-conjugated pirarubicin (P-THP), an innovative polymer-conjugated anticancer drug, has highly tumor-specific distribution owing to the enhanced permeability and retention (EPR) effect [3,4]. The authors explain the mechanism underlying the high tumor-selectivity of P-THP and the application of this agent to a wide variety of pediatric malignancies
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