Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5923_Библиотеки_им_академика_М_И_Перельмана

During the sixteenth-century, the pioneering physician Paracelsus was among the first to utilize medicine and minerals in the treatment of cancer. Up until 2020, the FDA had approved approximately 89 medications intended for the treatment of cancer [20]. These medications are categorized as alkylating agents, antimetabolites, anthracyclines, plant alkaloids, microtubule inhibitors or modulators, topoisom­erase inhibitors, chromosome binding agents, and other antitumor treatments. These drugs exhibited anticancer effects by causing DNA fragmentation, inhibiting topoisomerase activity, and inducing apoptosis through different mechanistic path­ways. In more than 90% of instances, chemotherapy is prescribed with the primary goal of providing palliative care, aiming to either stabilize the disease or enhance the patient’s quality of life. Regrettably, the limited rate of drug accumulation within cancer cells is insufficient to manage the rapid growth of tumors effectively. Therefore, combination therapy might be more effective in controlling the swift and proliferative cancer growth. Nonetheless, the intrinsic heterogeneous characteristics and hypoxic conditions significantly disrupt the effectiveness of anticancer drugs in chemotherapy. Even during advanced stages, various factors such as multidrug resis­tance, changes in drug activation mechanisms, detoxification, activation of cellular efflux, and delayed apoptosis further diminish the anticancer efficacy of chemo­therapy [21]. The idea of drug delivery emerges as a means to expand the therapeutic window, which is presently limited. In general, micro/macro encapsulated particles, polymer-bound micro drug delivery systems, and prodrug-linked low molecular weight drug delivery systems are frequently utilized. Ligand-receptor interaction­based targeted delivery system is the key strategy behind the effective transport of chemotherapeutics agents to the cancerous region. Generally, integrin-binding RGD peptide, folic acid, monoclonal antibody, glycoside, D-biotin, and similar substances are commonly employed for targeting different forms of cancer [22, 23]. Several thousand publications concerning drug delivery systems illustrate their internaliza­tion through either receptor-ligand interaction within the endocytosis pathway or passively through the concept of the enhanced permeable retention (EPR) effect. These endeavors are essential from the standpoint of patient care, reducing drug misuse, and minimizing mortality.