Improving the efficacy of combined modality anticancer therapy using HPMA copolymer-based nanomedicine formulations

Copolymers based on N-(2-hydroxypropyl)methacrylamide (HPMA) are prototypic and well-characterized polymeric drug carriers that have been broadly implemented in the delivery of anticancer agents. HPMA copolymers circulate for prolonged periods of time, and by means of the Enhanced Permeability and Retention (EPR) effect, they localize to tumors both effectively and selectively. Because of their beneficial biodistribution, and because of the fact that they are able to improve the balance between the efficacy and the toxicity of chemotherapy, it is reasonable to assume that HPMA copolymers combine well with other treatment modalities. In the present review, efforts in this regard are summarized, and HPMA copolymers are shown to be able to beneficially interact with surgery, with radiotherapy, with hyperthermia, with photodynamic therapy, with chemotherapy and with each other. Together, the insights provided and the evidence obtained strongly suggest that HPMA copolymer-based nanomedicine formulations hold significant potential for improving the efficacy of combined modality anticancer therapy. (C) 2009 Elsevier B.V. All rights reserved.