Sorafenib for the treatment of solid malignancies: what about the cancer microenvironment?

Ciprian Tomuleasa, Andrei Cucuianu, Mihaela Aldea, Ioana Berindan-Neagoe

Research Center of Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania

We have read with great interest the study of Kim et al, recently published in the International Journal of Nanomedicine.¹ The physicians from South Korea describe the anti-tumor efficacy of sorafenib in cholangiocarcinoma, a malignancy with a dismal prognosis and refractory to most chemotherapy options. Surgery is the only curative option, but is limited to only a small number of cases due to the late diagnosis.² This emphasizes the need to develop new approaches for such cases and the first potential new option is the tyrosine kinase inhibitor sorafenib, already proven to improve the therapeutic ratio of hepatocellular carcinoma, as according to Llovet et al.³ But unlike hepatocellular carcinoma, cholangiocarcinomas are epithelial cancers with a highly developed desmoplastic stroma due to the interaction between the cancer cell and the cancer associated fibroblasts (CAFs), as well as the macrophages, and the natural killer (NK) cells.⁴ This tumor microenvironment makes it difficult for a chemotherapy drug to reach the cancer cell and be efficient, which partially explains the reason why Kim et al¹ developed a sorafenib-coated stent, that can be placed inside the biliary tree and deliver the drug continuously.

View original paper by Kim and colleagues.