Novel platinum agents and mesenchymal stromal cells for thoracic malignancies: state of the art and future perspectives

ABSTRACT

Introduction: Non-small cell lung cancer and malignant pleural mesothelioma represent two of the most intriguing and scrutinized thoracic malignancies, presenting interesting perspectives of experimental development and clinical applications.

Areas covered: In advanced non-small cell lung cancer, molecular targeted therapy is the standard first-line treatment for patients with identified driver mutations; on the other hand, chemotherapy is the standard treatment for patients without EGFR mutations or ALK rearrangement or those with unknown mutation status. Once considered an ineffective therapy in pulmonary neoplasms, immunotherapy has been now established as one of the most promising therapeutic options.

Mesenchymal stromal cells are able to migrate specifically toward solid neoplasms and their metastatic localizations when injected intravenously. This peculiar cancer tropism has opened up an emerging field to use them as vectors to deliver antineoplastic drugs for targeted therapies.

Expert opinion: Molecular targeted therapy and immunotherapy are the new alternatives to standard chemotherapy. Mesenchymal stromal cells are a new promising tool in oncology and—although not yet utilized in the clinical practice, we think they will represent another main tool for cancer therapy and will probably play a leading role in the field of nanovectors and molecular medicine.

KEYWORDS:

• Non-small cell lung cancer
• malignant pleural mesothelioma
• immunotherapy
• targeted therapy
• mesenchymal stromal cell
• drug loading and delivery

Article highlights

• Lung cancer is the leading cause of cancer-related death worldwide and malignant pleural mesothelioma—although rare—is fatal asbestos-related tumor without any approved second-line treatments. Together they are, for different reasons, the most challenging diseases for thoracic surgeons nowadays.

• Although chemotherapy is still indicated in several non-small cell lung cancer, molecular targeted therapy and immunotherapy represent the new frontiers of daily clinical practice.

• Activating mutations in the epidermal growth factor receptor (EGFR) gene and translocations of the anaplastic lymphoma kinase (ALK) gene are the most important mutations with concrete clinical implications, although many others are known.

• Immunotherapy has been now established as one of the most promising therapeutic options both in NSCL and MPM; immune-checkpoint inhibitors have meaningful clinical activity and an acceptable safety profile both in NSCLC and MPM.

• Nanovector of anticancer compounds as well as mesenchymal stromal cells can potentially hide and protect the drug from being metabolized in the body before reaching their target site, thus enhancing tumor drug uptake and reducing drugs interaction with normal cells thereby decreasing clinical toxicity. They can be considered the future of antineoplastic drug development.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.