Synergistic Effects of Nanodrug , Ultrasound Hyperthermia , and Thermal Ablation on Solid Tumors — An Animal Study

<italic>Objective:</italic> Delivery barriers of nanodrug in large tumors due to heterogeneous blood supply, elevated interstitial pressure, and long transport distances can degrade the efficacy of cancer treatment. In this study, we proposed a therapeutic strategy to improve the tumor growth inhibition by injecting pegylated liposomal doxorubicin (PLD), and then applying a short time of ultrasound hyperthermia (HT) on the entire solid tumor, and inflicting ultrasound thermal ablation (Ab) in the low-perfused tumor region. <italic>Methods:</italic> BALB/c female mice with an average weight of 20 g were adopted and murine breast cancer cells 4T1 were subcutaneously implanted into the flank. A 1.0-MHz planar and a 0.47-MHz focused ultrasound transducers were used, respectively, for the HT and Ab treatment. <italic>Results:</italic> For a PLD dose of 5 mg/kg, the PLD + HT(42 °C, 10 min) group caused a significant decrease in the tumor size as compared with the control and the PLD group, but there were no significant differences between the PLD + HT group and the PLD + Ab(56 °C, 49 s) + HT group. For a PLD dose of 3 mg/kg, the tumor sizes among the four groups were mutually significant. The level of reduction in tumor was PLD + Ab + HT > PLD + HT > PLD > control. <italic>Conclusion:</italic> The combination of anticancer nanodrug and ultrasound thermal treatment could remarkably suppress cancer tumor growth with a minimum compromise of side effects. <italic>Significance:</italic> The strategy of using thermal Ab in locations that are not reached by nanodrug with mild HT shows a promising potential for the entire tumor treatment.

[1]  Joo Ha Hwang,et al.  Emerging HIFU applications in cancer therapy , 2015, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[2]  Peter Wust,et al.  Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. , 2010, The Lancet. Oncology.

[3]  H. Maeda,et al.  A new concept for macromolecular therapeutics in cancer chemotherapy: mechanism of tumoritropic accumulation of proteins and the antitumor agent smancs. , 1986, Cancer research.

[4]  K. Ferrara,et al.  Ultrasonic Enhancement of Drug Penetration in Solid Tumors , 2013, Front. Oncol..

[5]  R K Jain,et al.  Barriers to drug delivery in solid tumors. , 1994, Scientific American.

[6]  Theodoros Samaras,et al.  CEM43°C thermal dose thresholds: a potential guide for magnetic resonance radiofrequency exposure levels? , 2013, European Radiology.

[7]  K Hynynen,et al.  Ultrasound technology for hyperthermia. , 1999, Ultrasound in medicine & biology.

[8]  M. Junttila,et al.  Influence of tumour micro-environment heterogeneity on therapeutic response , 2013, Nature.

[9]  W. Dewey,et al.  Thermal dose determination in cancer therapy. , 1984, International journal of radiation oncology, biology, physics.

[10]  R. Kerbel Tumor angiogenesis: past, present and the near future. , 2000, Carcinogenesis.

[11]  Natalia Vykhodtseva,et al.  Targeted delivery of doxorubicin to the rat brain at therapeutic levels using MRI‐guided focused ultrasound , 2007, International journal of cancer.

[12]  Andras Szasz,et al.  Hyperthermia today: electric energy, a new opportunity in cancer treatment. , 2006, Journal of cancer research and therapeutics.

[13]  T. Dubinsky,et al.  High-intensity focused ultrasound: current potential and oncologic applications. , 2008, AJR. American journal of roentgenology.

[14]  R. Jain,et al.  Role of extracellular matrix assembly in interstitial transport in solid tumors. , 2000, Cancer research.

[15]  H. Park,et al.  Implications of increased tumor blood flow and oxygenation caused by mild temperature hyperthermia in tumor treatment , 2005, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[16]  A. Hart,et al.  Comparison of radiotherapy alone with radiotherapy plus hyperthermia in locally advanced pelvic tumours: a prospective, randomised, multicentre trial , 2000, The Lancet.

[17]  Dieter Haemmerich,et al.  Improved intratumoral nanoparticle extravasation and penetration by mild hyperthermia. , 2013, Journal of controlled release : official journal of the Controlled Release Society.

[18]  G. Hahn,et al.  Hyperthermia induces doxorubicin release from long-circulating liposomes and enhances their anti-tumor efficacy. , 1994, International journal of radiation oncology, biology, physics.

[19]  A. Santoro,et al.  Reduced cardiotoxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin HCl (CAELYX/Doxil) versus conventional doxorubicin for first-line treatment of metastatic breast cancer. , 2004, Annals of oncology : official journal of the European Society for Medical Oncology.

[20]  C. Song Effect of local hyperthermia on blood flow and microenvironment: a review. , 1984, Cancer research.

[21]  V. Huxley,et al.  Differential actions of albumin and plasma on capillary solute permeability. , 1991, The American journal of physiology.

[22]  Win-Li Lin,et al.  Short-time focused ultrasound hyperthermia enhances liposomal doxorubicin delivery and antitumor efficacy for brain metastasis of breast cancer , 2014, International journal of nanomedicine.

[23]  Ming-Chih Chou,et al.  Clinical Application of High-intensity Focused Ultrasound in Cancer Therapy , 2016, Journal of Cancer.

[24]  S Nahum Goldberg,et al.  Image-guided tumor ablation: standardization of terminology and reporting criteria. , 2005, Journal of vascular and interventional radiology : JVIR.

[25]  Shery Jacob,et al.  A simple practice guide for dose conversion between animals and human , 2016, Journal of basic and clinical pharmacy.

[26]  D. Hanahan,et al.  Patterns and Emerging Mechanisms of the Angiogenic Switch during Tumorigenesis , 1996, Cell.

[27]  J. Kennedy High-intensity focused ultrasound in the treatment of solid tumours , 2005, Nature Reviews Cancer.

[28]  Akihiro Tojo,et al.  Mechanisms of Glomerular Albumin Filtration and Tubular Reabsorption , 2012, International journal of nephrology.

[29]  R. M. Arthur,et al.  Non-invasive estimation of hyperthermia temperatures with ultrasound , 2005, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[30]  S. Libutti,et al.  Pulsed-High Intensity Focused Ultrasound and Low Temperature–Sensitive Liposomes for Enhanced Targeted Drug Delivery and Antitumor Effect , 2007, Clinical Cancer Research.

[31]  Rakesh K. Jain,et al.  Vascular and interstitial barriers to delivery of therapeutic agents in tumors , 1990, Cancer and Metastasis Reviews.

[32]  M. Dewhirst,et al.  Characterization of the effect of hyperthermia on nanoparticle extravasation from tumor vasculature. , 2001, Cancer research.

[33]  M. Bally,et al.  The role of tumor-associated macrophages in the delivery of liposomal doxorubicin to solid murine fibrosarcoma tumors. , 1997, The Journal of pharmacology and experimental therapeutics.

[34]  M. Roizen,et al.  Hallmarks of Cancer: The Next Generation , 2012 .

[35]  E. Alphandéry Perspectives of Breast Cancer Thermotherapies , 2014, Journal of Cancer.

[36]  S. Vinogradov,et al.  Cancer stem cells and drug resistance: the potential of nanomedicine. , 2012, Nanomedicine.

[37]  H. Maeda,et al.  Tumor vascular permeability and the EPR effect in macromolecular therapeutics: a review. , 2000, Journal of controlled release : official journal of the Controlled Release Society.

[38]  J. Folkman,et al.  ANGIOGENESIS: INITIATION AND CONTROL * , 1982, Annals of the New York Academy of Sciences.