According to a modern view, cancer no longer follows a purely mechanistic model. Rather, a tumor is conceived as a more complex structure, composed of cancer cells, the activities of which may interact and reshape the so-called tumor microenvironment (TME), leading to preservation of specific tumoral niches and promoting the survival of tumoral stem cells.Background/Objective: Therapeutic strategies must deal with this unique cancer architecture in the near future by widening their range of activities outside the cancer cells and rewiring a TME to ensure it is hostile to cancer growth. Therefore, an intratumoral therapeutic strategy may open the door to a new type of anticancer activity, one that directly injures the tumoral structure while also eliciting an influence on the TME through local and systemic immunomodulation. This review would like to assess the current situation of intratumoral strategies and their clinical implications.MethodsWe analyzed data from phase I, II, and III trials, comprehensive reviews and relevant clinical and preclinical research, from robust databases, like PUBMED, EMBASE, Cochrane Library, and clinicaltrials.gov.Results:Intratumoral strategies can be quite variable. It is possible the injection and inhalation of traditional antiblastic agents or immunomodulant agents, or intrapleural administration. Ablation strategy is available, both thermal and photodynamic method. Moreover, TTfields and NPs are analyzed and also brachytherapy is mentioned. Intratumoral therapy can find space in “adjuvant”/perioperative or metastatic settings. Finally, intratumoral strategies allow to synergize their activities with systemic therapies, guaranteeing better local and systemic disease control.Conclusions:Intratumoral strategies are overall promising. Antiblastic/immunomodulant injection and NPs use are especially interesting and intriguing. But, there is generally a lack of phase II and III trials, in particular NPs use need additional experimentation and clinical studies.
根据现代观点，癌症不再遵循纯粹的机械论模型。相反，肿瘤被构想为一种更为复杂的结构，由癌细胞组成，其活动可能相互作用并重塑所谓的肿瘤微环境（TME），从而维持特定的肿瘤生态位并促进肿瘤干细胞的存活。 背景/目的：治疗策略必须在不久的将来通过扩大其在癌细胞以外的活动范围并重新调整TME，使其不利于癌症生长，以应对这种独特的癌症结构。因此，瘤内治疗策略可能开启一种新型的抗癌活动，这种策略不仅直接损伤肿瘤结构，还通过局部和全身免疫调节对TME产生影响。本综述旨在评估瘤内策略的现状及其临床意义。 方法：我们分析了来自I期、II期和III期试验的数据，以及来自可靠数据库（如PUBMED、EMBASE、Cochrane Library和clinicaltrials.gov）的综合综述和相关临床及临床前研究。 结果：瘤内策略可以非常多样化。可能包括传统抗肿瘤药物或免疫调节剂的注射和吸入，或胸膜内给药。消融策略也是可行的，包括热消融和光动力疗法。此外，还分析了肿瘤治疗电场（TTfields）和纳米颗粒（NPs）的应用，并提及了近距离放射治疗。瘤内治疗可在“辅助”/围手术期或转移性环境中找到应用空间。最后，瘤内策略能够与全身治疗协同作用，确保更好的局部和全身疾病控制。 结论：瘤内策略总体上是具有前景的。抗肿瘤/免疫调节剂注射和纳米颗粒的应用尤其引人关注和有趣。然而，普遍缺乏II期和III期试验，特别是纳米颗粒的应用需要进一步的实验和临床研究。
Intratumoral Treatment in Lung Cancer: Is It Time to Move Towards Clinical Practice?
肿瘤(癌症)患者之家