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Review | Open Access

Smart drug delivery systems to overcome drug resistance in cancer immunotherapy

Wenzhe Yi1,2,*, Dan Yan1,3,*, Dangge Wang1,2,4 ( ), Yaping Li1,2,5 ( )
State Key Laboratory of Drug Research & Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
University of Chinese Academy of Sciences, Beijing 100049, China
Department of Pharmaceutics, School of Pharmacy, Nanjing Medical University, Nanjing 211116, China
Yantai Key Laboratory of Nanomedicine & Advanced Preparations, Yantai Institute of Materia Medica, Yantai 264000, China
Shandong Laboratory of Yantai Drug Discovery, Bohai Rim Advanced Research Institute for Drug Discovery, Yantai 264000, China

*These authors contributed equally to this work.

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Abstract

Cancer immunotherapy, a therapeutic approach that inhibits tumors by activating or strengthening anti-tumor immunity, is currently an important clinical strategy for cancer treatment; however, tumors can develop drug resistance to immune surveillance, resulting in poor response rates and low therapeutic efficacy. In addition, changes in genes and signaling pathways in tumor cells prevent susceptibility to immunotherapeutic agents. Furthermore, tumors create an immunosuppressive microenvironment via immunosuppressive cells and secrete molecules that hinder immune cell and immune modulator infiltration or induce immune cell malfunction. To address these challenges, smart drug delivery systems (SDDSs) have been developed to overcome tumor cell resistance to immunomodulators, restore or boost immune cell activity, and magnify immune responses. To combat resistance to small molecules and monoclonal antibodies, SDDSs are used to co-deliver numerous therapeutic agents to tumor cells or immunosuppressive cells, thus increasing the drug concentration at the target site and improving efficacy. Herein, we discuss how SDDSs overcome drug resistance during cancer immunotherapy, with a focus on recent SDDS advances in thwarting drug resistance in immunotherapy by combining immunogenic cell death with immunotherapy and reversing the tumor immunosuppressive microenvironment. SDDSs that modulate the interferon signaling pathway and improve the efficacy of cell therapies are also presented. Finally, we discuss potential future SDDS perspectives in overcoming drug resistance in cancer immunotherapy. We believe that this review will contribute to the rational design of SDDSs and development of novel techniques to overcome immunotherapy resistance.

Keywords

drug resistanceCancer immunotherapyimmunosuppressive microenvironmentsmart drug delivery systemimmune cell

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Cancer Biology & Medicine
Volume 20 Issue 4,
April 2023
Pages 248-267
DOI: 10.20892/j.issn.2095-3941.2023.0009
Cite this article:
Yi W, Yan D, Wang D, et al. Smart drug delivery systems to overcome drug resistance in cancer immunotherapy. Cancer Biology & Medicine, 2023, 20(4): 248-267. https://doi.org/10.20892/j.issn.2095-3941.2023.0009

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Received: 12 January 2023
Accepted: 27 March 2023
Published: 04 May 2023
©2023 Cancer Biology & Medicine.

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