Download IA15IL53 - Inhalation Asia 2017

IA15IL53
Aerosolized Chemotherapy: An Emerging Treatment for Lung Cancer
Rajiv Dhand, MD, FCCP, FACP, FAARC
Professor of Medicine, Chairman of the Department of Medicine and Associate Dean,
Graduate School of Medicine, University of Tennessee, Knoxville, TN 37920, USA
Lung cancer is an important worldwide public health problem. Surgical resection is the
preferred treatment for Stage I and Stage II lung cancers; whereas more advanced lung
cancers (Stages III and IV) are treated with chemotherapy and/or radiation therapy.
Despite recent advances in diagnosis and treatment, conventional methods of treatment
fail to provide a cure in more than 80% of patients with lung cancer.
Within the changing paradigm of lung cancer diagnosis and treatment, chemotherapy
has remained as an important part of the therapeutic armamentarium. In addition to its
established role for treatment of advanced (Stages III and IV) lung cancers, adjuvant
systemic chemotherapy is also being employed after surgical resection of early (Stage
II) lung cancers. The major disadvantage of systemically administered chemotherapy is
that drug toxicity limits the dose that could be safely administered, and cancers recur
because they become refractory to the effects of the drugs.
In several cancers, regional chemotherapy has been successfully employed to
administer higher and more effective doses of chemotherapy. Aerosolized
chemotherapy provides a similar regional approach to the treatment of lung cancer,
especially for non-small cell lung cancer (NSCLC) and multifocal or metastatic tumors.
Aerosolized chemotherapy has the potential to increase exposure of tumors to higher
levels of drugs while reducing their systemic toxicity and represents a fertile area for
further investigation. Several methods of targeting inhaled agents to the site of the
tumor(s) within the lung are being investigated to protect the normal lung tissues from
local toxic effects. These approaches include: regional targeting by introduction of
aerosol at different volumes of inhalation; enhanced condensational growth; utilizing
intracorporeal nebulization catheters for aerosol delivery; use of external magnetic
fields; or targeting receptors on cancer cells with specific ligands. Concurrent
development of liposomal and nanoparticle formulations seeks to improve the safety
and residence time of chemotherapeutic agents within the lung. With these techniques,
chemotherapy levels achieved in the lungs could be safely increased several-fold while
minimizing systemic toxicity.
Early phase clinical trials have shown that inhaled chemotherapy is effective for
treatment of lung cancers, and it could play an important role as an adjunct to other
forms of treatment. Further investigations of several modalities that target aerosols to
lung cancers, safeguard the health of care providers, and protect the environment are
needed to establish optimal protocols for inhaled chemotherapy.