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Kamal et al. J Cancer Metastasis Treat 2019;5:11 Journal of Cancer
DOI: 10.20517/2394-4722.2018.89 Metastasis and Treatment

Review Open Access

Is active targeting of brain metastases of breast
cancer superior to passive targeting?

Nermeen H. Kamal *, Fatema El-Amrawy *, Heba Abdullah Ali , Ivan Edafiogho , Mohamed Ismail
2,
1,
3
4
Nounou 4
1 Department of Pharmaceutics, College of pharmacy, Arab Academy for Science, Technology and Maritime Transport
(AASTMT), Alexandria 1029, Egypt.
2 Biomedical Informatics and Medical Statistics Department, Medical Research Institute (MRI), Alexandria University, Alexandria
21561, Egypt.
3 Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy for Girls, Al Azhar University, Cairo 11651, Egypt.
4 Department of Pharmaceutical Sciences (DPS), School of Pharmacy and Physician Assistant Studies (SOPPAS), University of
Saint Joseph (USJ), Hartford, CT 06103, USA.
*Both authors contributed equally to the manuscript and are both considered first authors.

Correspondence to: Dr. Mohamed Ismail Nounou, Department of Pharmaceutical Sciences (DPS), School of Pharmacy and
Physician Assistant Studies (SOPPAS), University of Saint Joseph (USJ), Hartford, CT 06103, USA. E-mail: nounou@usj.edu

How to cite this article: Kamal NH, El-Amrawy F, Ali HA, Edafiogho I, Nounou MI. Is active targeting of brain metastases of breast
cancer superior to passive targeting? J Cancer Metastasis Treat 2019;5:11. http://dx.doi.org/10.20517/2394-4722.2018.89

Received: 7 Dec 2018 First Decision: 29 Dec 2018 Revised: 7 Jan 2019 Accepted: 22 Jan 2019 Published: 20 Feb 2019

Science Editor: William P. Schiemann Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu

Abstract
Brain metastasis is a major cause of death in patients with solid cancers. Breast cancer cells have high tendency
to migrate towards brain. Cancer cells within brain are characterized by severe aggressiveness and inaccessibility.
Currently, breast cancer and its metastasis are the second leading cause of death among women. Tumor
microenvironment and blood brain barrier (BBB) represent great obstacles in targeting breast cancer and its
metastasis. Chemotherapy is a safer treatment modality for brain metastasis compared with risky surgical
resection and brain radiotherapy. Unfortunately, conventional chemotherapy lack penetration of BBB and suffer
from multiple resistance mechanisms. Current treatment technologies for brain metastases of breast cancer
have limited long-term success and numerous side effects, illustrating the urgent need for novel smart strategies.
Various novel drug entities and nanosystems have been employed to improve diagnosis and targeted treatment of
breast cancer and its metastasis. Immunotherapy agents and small tyrosine kinase inhibitors have been shown to
reduce tumor size and increase survival in patients with breast cancer, but still poorly penetrate BBB. Tailored sized
nanoparticles to some extent crossed brain tumor barrier and enhanced drug accumulation in tumors by taking
advantage of enhanced permeability and retention. Furthermore, various active targeting strategies have been
adopted to improve accessibility to brain malignancies. Therefore, to achieve enhanced antitumor therapy against
© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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