Tamoxifen (TAM) resistance remains a significant challenge in treating estrogen receptor (ER)-positive breast cancer. Overexpression of epidermal growth factor receptor (EGFR), variations in TAM metabolism, and increased expression of drug-resistant proteins (P-glycoprotein, P-gp) all contribute to the development of TAM-resistant breast cancer. The lack of specific drug distribution to tumors further complicates the treatment of TAM-resistant breast cancer. Simultaneously addressing these four factors—EGFR overexpression, TAM metabolic variations, P-gp-mediated drug efflux, and poor tumor-specific delivery—can significantly enhance the treatment of TAM-resistant breast cancer. This study aimed to design a multifunctional and dual-targeting polymeric prodrug nanomicelle platform. The platform was self-assembled using the amphipathic precursor drug material hyaluronic acid (HA)-4-hydroxytamoxifen (4-OH-TAM) ester (esterified by HA and 4-OH-TAM) and D-α-tocopheryl polyethylene glycol succinate (TPGS), loaded with dasatinib (DAS). The nanosystem could target breast cancer mediated by HA and 4-OH-TAM, releasing DAS, 4-OH-TAM, and TPGS in tumor microenvironment. 4-OH-TAM, an active metabolite of TAM, substantially impacted TAM-resistant breast cancer by avoiding the metabolic differences in TAM. TPGS inhibited P-gp-mediated drug efflux, thereby increasing intracellular accumulation of DAS and enhancing its inhibitory effect on TAM-resistant breast cancer cells. The results showed that the nanomicelles released drugs in a pH-sensitive manner. The cumulative release rates of 4-OH-TAM and DAS were (72.73 ± 3.99)% and (78.39 ± 3.09)%, respectively, within 48 h in a pH 5.0 solution, significantly higher than those in pH 6.0 and 7.4 solutions. The findings regarding cellular uptake and biodistribution indicated that the nanomicelles exhibited effective targeting capabilities toward TAM-resistant breast cancer. Both in vitro and in vivo studies demonstrated a marked effect of nanomicelles against TAM-resistant breast cancer through the targeting characteristic of nanoparticles and the actions of drugs (4-OH-TAM, DAS, and TPGS). The study provides fresh perspectives and suggestions for the clinical treatment of TAM-resistant breast cancer.
Ji et al. (Sun,) studied this question.
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