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Overcoming tumor hypoxia as a barrier to radiotherapy, chemotherapy and immunotherapy in cancer treatment

Authors Graham K, Unger E

Received 13 April 2018

Accepted for publication 11 July 2018

Published 4 October 2018 Volume 2018:13 Pages 6049—6058

DOI https://doi.org/10.2147/IJN.S140462

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Alicia Fernandez-Fernandez

Peer reviewer comments 3

Editor who approved publication: Dr Thomas J Webster


Video abstract presented by Kaitlin Graham.

Views: 179

Kaitlin Graham, Evan Unger

NuvOx Pharma, Tucson, AZ, USA

Abstract: Hypoxia exists to some degree in most solid tumors due to inadequate oxygen delivery of the abnormal vasculature which cannot meet the demands of the rapidly proliferating cancer cells. The levels of oxygenation within the same tumor are highly variable from one area to another and can change over time. Tumor hypoxia is an important impediment to effective cancer therapy. In radiotherapy, the primary mechanism is the creation of reactive oxygen species; hypoxic tumors are therefore radiation resistant. A number of chemotherapeutic drugs have been shown to be less effective when exposed to a hypoxic environment which can lead to further disease progression. Hypoxia is also a potent barrier to effective immunotherapy in cancer treatment. Because of the recognition of hypoxia as an important barrier to cancer treatment, a variety of approaches have been undertaken to overcome or reverse tumor hypoxia. Such approaches have included breathing hyperbaric oxygen, artificial hemoglobins, allosteric hemoglobin modifiers, hypoxia activated prodrugs and fluorocarbons (FCs). These approaches have largely failed due to limited efficacy and/or adverse side effects. Oxygen therapeutics, based on liquid FCs, can potentially increase the oxygen-carrying capacity of the blood to reverse tumor hypoxia. Currently, at least two drugs are in clinical trials to reverse tumor hypoxia; one of these is designed to improve permeability of oxygen into the tumor tissue and the other is based upon a low boiling point FC that transports higher amounts of oxygen per gram than previously tested FCs.

Keywords: fluorocarbon, solid tumor, oxygen therapeutics, dodecafluoropentane emulsion

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