Abstract
Etoposide is a semisynthetic derivative of podophyllotoxin widely used as a chemotherapeutic agent in the treatment of various malignancies such as lung cancer, testicular cancer, lymphomas, and leukemias. Despite its proven clinical efficacy, its therapeutic use is limited due to poor aqueous solubility, variable oral bioavailability, systemic toxicity, and the development of multidrug resistance. Conventional dosage forms of etoposide often fail to achieve optimal therapeutic outcomes and are associated with severe side effects. Liposomal drug delivery systems have emerged as a promising approach to overcome these challenges by improving solubility, protecting the drug from degradation, prolonging circulation half-life, enhancing tumor accumulation through the enhanced permeability and retention effect, and reducing systemic adverse effects.This review article provides a detailed discussion on the formulation and evaluation of liposomal drug delivery systems for etoposide. It highlights the fundamental challenges of conventional etoposide therapy, the design and preparation of liposomes, and the formulation strategies employed to optimize etoposide-loaded liposomes. In addition, key evaluation parameters such as particle size, zeta potential, drug entrapment efficiency, stability, and release kinetics are discussed in detail. Preclinical and clinical findings are summarized to illustrate the therapeutic advantages of liposomal etoposide. Furthermore, the article explores recent advancements in targeted and stimuli-responsive liposomes, challenges in large-scale development, and future directions in cancer nanomedicine. By integrating current scientific insights with critical evaluation, this review aims to provide a comprehensive understanding of the role of liposomal delivery systems in enhancing the therapeutic potential of etoposide and paving the way for improved patient outcomes in oncology.
Keywords
Etoposide, liposomes, anticancer therapy, drug delivery systems, nanomedicine, formulation, evaluation, pharmacokinetics, chemotherapy
Introduction
Cancer is one of the leading causes of mortality and morbidity worldwide, representing a major global health challenge [1]. The management of cancer often involves chemotherapy, radiotherapy, surgery, or a combination of these modalities. Among these, chemotherapy plays a critical role, especially in metastatic or systemic malignancies. However, conventional chemotherapy is associated with several limitations, including poor selectivity, systemic toxicity, and the emergence of drug resistance [2]. These challenges significantly compromise therapeutic efficacy and patient quality of life.
Reference
- Siegel, R. L., Miller, K. D., & Jemal, A. (2020). Cancer statistics, 2020. CA: A Cancer Journal for Clinicians, 70(1), 7–30. https://doi.org/10.3322/caac.21590
- Holohan, C., Van Schaeybroeck, S., Longley, D. B., & Johnston, P. G. (2013). Cancer drug resistance: An evolving paradigm. Nature Reviews Cancer, 13(10), 714–726. https://doi.org/10.1038/nrc3599
- Pommier, Y. (2006). Topoisomerase II inhibitors: Etoposide and beyond. Nature Reviews Cancer, 6(10), 789–802. https://doi.org/10.1038/nrc1977
- Hande, K. R. (1998). Etoposide: Four decades of development of a topoisomerase II inhibitor. European Journal of Cancer, 34(10), 1514–1521. https://doi.org/10.1016/S0959-8049(98)00197-2
- Kummar, S., Chen, A. P., Wright, J., et al. (2007). Phase I study of oral etoposide in patients with advanced solid tumors. Clinical Cancer Research, 13(11), 3377–3383. https://doi.org/10.1158/1078-0432.CCR-06-2708
- Gelderblom, H., Verweij, J., Nooter, K., & Sparreboom, A. (2001). Cremophor EL: The drawbacks and advantages of vehicle selection for drug formulation. European Journal of Cancer, 37(13), 1590–1598. https://doi.org/10.1016/S0959-8049(01)00142-2
- McGuire, W. P., Hoskins, W. J., Brady, M. F., et al. (1996). Cyclophosphamide and etoposide in combination therapy. Journal of Clinical Oncology, 14(5), 1646–1655. https://doi.org/10.1200/JCO.1996.14.5.1646
- Allen, T. M., & Cullis, P. R. (2013). Liposomal drug delivery systems: From concept to clinical applications. Advanced Drug Delivery Reviews, 65(1), 36–48. https://doi.org/10.1016/j.addr.2012.09.037
- Bozzuto, G., & Molinari, A. (2015). Liposomes as nanomedical devices. International Journal of Nanomedicine, 10, 975–999. https://doi.org/10.2147/IJN.S68861
- Sercombe, L., Veerati, T., Moheimani, F., et al. (2015). Advances and challenges of liposome assisted drug delivery. Frontiers in Pharmacology, 6, 286. https://doi.org/10.3389/fphar.2015.00286
- Barenholz, Y. (2012). Doxil® — The first FDA-approved nano-drug: Lessons learned. Journal of Controlled Release, 160(2), 117–134. https://doi.org/10.1016/j.jconrel.2012.03.020
- Torchilin, V. P. (2005). Recent advances with liposomes as pharmaceutical carriers. Nature Reviews Drug Discovery, 4(2), 145–160. https://doi.org/10.1038/nrd1632
- Maeda, H., Wu, J., Sawa, T., Matsumura, Y., & Hori, K. (2000). Tumor vascular permeability and the EPR effect in macromolecular therapeutics: A review. Journal of Controlled Release, 65(1–2), 271–284. https://doi.org/10.1016/S0168-3659(99)00248-5
- Gabizon, A., Shmeeda, H., & Barenholz, Y. (2003). Pharmacokinetics of pegylated liposomal Doxorubicin: Review of animal and human studies. Clinical Pharmacokinetics, 42(5), 419–436. https://doi.org/10.2165/00003088-200342050-00002
- Slater, E. P., & Folkman, J. (1984). Podophyllotoxin and derivatives as anticancer agents. Cancer Treatment Reviews, 11(3), 165–182. https://doi.org/10.1016/S0305-7372(84)80005-5
- Kinghorn, A. D., & Pan, L. (2012). Etoposide: Chemistry and pharmacology. Natural Product Reports, 29(8), 967–988. https://doi.org/10.1039/c2np20035f
- Hande, K. R. (1998). Etoposide: Four decades of development of a topoisomerase II inhibitor. European Journal of Cancer, 34(10), 1514–1521. https://doi.org/10.1016/S0959-8049(98)00197-2
- Pommier, Y., Leo, E., Zhang, H., & Marchand, C. (2010). DNA topoisomerases and their poisoning by anticancer and antibacterial drugs. Chemistry & Biology, 17(5), 421–433. https://doi.org/10.1016/j.chembiol.2010.04.012
- Gewirtz, D. A. (1999). A critical evaluation of the mechanisms of action proposed for the antitumor effects of the anthracycline antibiotics. Biochemical Pharmacology, 57(7), 727–741. https://doi.org/10.1016/S0006-2952(98)00399-1
- Gelderblom, H., Verweij, J., Nooter, K., & Sparreboom, A. (2001). Cremophor EL: The drawbacks and advantages of vehicle selection for drug formulation. European Journal of Cancer, 37(13), 1590–1598. https://doi.org/10.1016/S0959-8049(01)00142-2
- Kummar, S., Chen, A. P., Wright, J., et al. (2007). Phase I study of oral etoposide in patients with advanced solid tumors. Clinical Cancer Research, 13(11), 3377–3383. https://doi.org/10.1158/1078-0432.CCR-06-2708
- Sparreboom, A., & Verweij, J. (1999). Pharmacokinetics of etoposide and determinants of oral bioavailability. Clinical Pharmacokinetics, 36(6), 447–460. https://doi.org/10.2165/00003088-199936060-00002
- Hande, K. R. (1998). Etoposide: Four decades of development of a topoisomerase II inhibitor. European Journal of Cancer, 34(10), 1514–1521. https://doi.org/10.1016/S0959-8049(98)00197-2
- Gelderblom, H., et al. (2001). European Journal of Cancer, 37(13), 1590–1598.
- McGuire, W. P., et al. (1996). Journal of Clinical Oncology, 14(5), 1646–1655.
- Holohan, C., et al. (2013). Nature Reviews Cancer, 13(10), 714–726.
- Pommier, Y. (2006). Nature Reviews Cancer, 6(10), 789–802.
- Allen, T. M., & Cullis, P. R. (2013). Advanced Drug Delivery Reviews, 65(1), 36–48.
- Bozzuto, G., & Molinari, A. (2015). International Journal of Nanomedicine, 10, 975–999.
- Bangham, A. D., Standish, M. M., & Watkins, J. C. (1965). Diffusion of univalent ions across the lamellae of swollen phospholipids. Journal of Molecular Biology, 13(1), 238–252. https://doi.org/10.1016/S0022-2836(65)80199-0
- Gregoriadis, G. (1995). Engineering liposomes for drug delivery: Progress and problems. Trends in Biotechnology, 13(12), 527–537. https://doi.org/10.1016/S0167-7799(00)88934-4
- Allen, T. M. (1994). Liposomal drug formulations: Rationale and prospects for cancer therapy. Drugs, 47(1), 25–36. https://doi.org/10.2165/00003495-199447010-00003
- Gabizon, A., et al. (2003). Clinical Pharmacokinetics, 42(5), 419–436.
- Lasic, D. D., & Papahadjopoulos, D. (1998). Medical Applications of Liposomes. Elsevier.
- Yatvin, M. B., Weinstein, J. N., Dennis, W. H., & Blumenthal, R. (1978). Design of liposomes for enhanced local release of drugs by hyperthermia. Science, 202(4374), 1290–1293. https://doi.org/10.1126/science.688834
- Bangham, A. D., et al. (1965). Journal of Molecular Biology, 13(1), 238–252.
- Torchilin, V. P. (2005). Nature Reviews Drug Discovery, 4(2), 145–160.
- Maeda, H., Wu, J., Sawa, T., Matsumura, Y., & Hori, K. (2000). Tumor vascular permeability and the EPR effect in macromolecular therapeutics: A review. Journal of Controlled Release, 65(1–2), 271–284. https://doi.org/10.1016/S0168-3659(99)00248-5
- Barenholz, Y. (2012). Doxil® — The first FDA-approved nano-drug: Lessons learned. Journal of Controlled Release, 160(2), 117–134. https://doi.org/10.1016/j.jconrel.2012.03.020
- Harde, H., Das, M., & Jain, S. (2011). Liposomes: Preparation, characterization and applications. International Journal of Pharmaceutical Sciences Review and Research, 7(2), 1–8.
- Bangham, A. D., Standish, M. M., & Watkins, J. C. (1965). Diffusion of univalent ions across the lamellae of swollen phospholipids. Journal of Molecular Biology, 13(1), 238–252. https://doi.org/10.1016/S0022-2836(65)80199-0
- Szoka, F., & Papahadjopoulos, D. (1980). Comparative properties and methods of preparation of lipid vesicles (liposomes). Annual Review of Biophysics and Bioengineering, 9, 467–508. https://doi.org/10.1146/annurev.bb.09.060180.002343
- Jahn, A., Vreeland, W. N., Gaitan, M., & Locascio, L. E. (2004). Controlled vesicle self-assembly in microfluidic channels with hydrodynamic focusing. Journal of the American Chemical Society, 126(9), 2674–2675. https://doi.org/10.1021/ja039725u
- Cegelski, L., & Vreeland, W. N. (2011). Liposome microfluidic technologies for drug delivery. Lab on a Chip, 11(22), 3826–3836. https://doi.org/10.1039/c1lc20543a
- New, R. R. C. (1990). Liposomes: A Practical Approach. Oxford University Press.
- Mozafari, M. R. (2005). Liposomes: An overview of manufacturing techniques. Cellular and Molecular Biology Letters, 10(4), 711–719.
- Immordino, M. L., Dosio, F., & Cattel, L. (2006). Stealth liposomes: Review of the basic science, rationale, and clinical applications, existing and potential. International Journal of Nanomedicine, 1(3), 297–315. https://doi.org/10.2147/nano.2006.1.3.297
- Akbarzadeh, A., Rezaei-Sadabady, R., Davaran, S., et al. (2013). Liposome: Classification, preparation, and applications. Nanoscale Research Letters, 8, 102. https://doi.org/10.1186/1556-276X-8-102
- Torchilin, V. P. (2005). Recent advances with liposomes as pharmaceutical carriers. Nature Reviews Drug Discovery, 4(2), 145–160. https://doi.org/10.1038/nrd1632
- Patil, Y., & Jadhav, S. (2014). Liposomal drug delivery: A comprehensive review. International Journal of Pharmaceutical Research & Development, 6(11), 1–10.
- Gupta, A., & Kumar, P. (2010). Liposome drug delivery system: A review. Journal of Advanced Pharmaceutical Technology & Research, 1(4), 374–382. https://doi.org/10.4103/2231-4040.90790
- Shaji, J., & Patole, V. (2008). Protein and peptide drug delivery: Oral approaches. Indian Journal of Pharmaceutical Sciences, 70(3), 269–277. https://doi.org/10.4103/0250-474X.43017
- Mozafari, M. R., Johnson, C., Hatziantoniou, S., & Demetzos, C. (2008). Nanoliposomes and their applications in food and pharmaceutical sectors. Journal of Liposome Research, 18(3), 309–327. https://doi.org/10.1080/08982100802335964
- Deshpande, P., Bisht, S., & Maitra, A. (2009). Evaluation of liposomal anticancer drug formulations. Current Opinion in Investigational Drugs, 10(12), 1334–1341.
- Wang, Y., & Yu, H. (2014). Characterization of liposomal drug delivery systems: Particle size and PDI. Journal of Pharmaceutical Analysis, 4(5), 295–302. https://doi.org/10.1016/j.jpha.2014.06.001
- Jain, S., & Jain, R. (2015). Zeta potential and stability evaluation of liposomes: A review. International Journal of Pharmaceutical Sciences and Research, 6(3), 882–890. https://doi.org/10.13040/IJPSR.0975-8232.6(3).882-90
- Akbarzadeh, A., et al. (2013). Liposome: Classification, preparation, and applications. Nanoscale Research Letters, 8, 102. https://doi.org/10.1186/1556-276X-8-102
- ozafari, M. R. (2005). Liposomes: An overview of manufacturing techniques. Cellular and Molecular Biology Letters, 10(4), 711–719.
- Kulkarni, A., & Feng, S. S. (2013). In vitro drug release from liposomes: Methods and kinetics. International Journal of Pharmaceutics, 458(1), 116–123. https://doi.org/10.1016/j.ijpharm.2013.09.015
- Immordino, M. L., et al. (2006). Stealth liposomes: Review of the basic science, rationale, and clinical applications. International Journal of Nanomedicine, 1(3), 297–315. https://doi.org/10.2147/nano.2006.1.3.297
- Deshpande, P., et al. (2009). Evaluation of liposomal anticancer drug formulations. Current Opinion in Investigational Drugs, 10(12), 1334–1341.
- Allen, T. M., & Cullis, P. R. (2013). Liposomal drug delivery systems: From concept to clinical applications. Advanced Drug Delivery Reviews, 65(1), 36–48. https://doi.org/10.1016/j.addr.2012.09.037
- Bozzuto, G., & Molinari, A. (2015). Liposomes as nanomedical devices. International Journal of Nanomedicine, 10, 975–999. https://doi.org/10.2147/IJN.S68861
- Immordino, M. L., Dosio, F., & Cattel, L. (2006). Stealth liposomes: Review of the basic science, rationale, and clinical applications. International Journal of Nanomedicine, 1(3), 297–315. https://doi.org/10.2147/nano.2006.1.3.297
- Gabizon, A., Shmeeda, H., & Barenholz, Y. (2003). Pharmacokinetics of pegylated liposomal doxorubicin: Review of animal and human studies. Clinical Pharmacokinetics, 42(5), 419–436. https://doi.org/10.2165/00003088-200342050-00002
- Allen, T. M., Hansen, C. B., de Menezes, D., et al. (1991). Liposomes containing synthetic lipid derivatives of poly(ethylene glycol) show prolonged circulation half-lives in vivo. Biochimica et Biophysica Acta (BBA) – Biomembranes, 1066(1), 29–36. https://doi.org/10.1016/0005-2736(91)90143-X
- Maeda, H. (2001). The enhanced permeability and retention (EPR) effect in tumor vasculature: The key for tumor-selective drug targeting. Advances in Enzyme Regulation, 41, 189–207. https://doi.org/10.1016/S0065-2571(00)00013-3
- Immordino, M. L., et al. (2006). Stealth liposomes: Review of the basic science, rationale, and clinical applications. International Journal of Nanomedicine, 1(3), 297–315. https://doi.org/10.2147/nano.2006.1.3.297
- Allen, T. M., & Cullis, P. R. (2013). Liposomal drug delivery systems: From concept to clinical applications. Advanced Drug Delivery Reviews, 65(1), 36–48. https://doi.org/10.1016/j.addr.2012.09.037
- Torchilin, V. P. (2005). Recent advances with liposomes as pharmaceutical carriers. Nature Reviews Drug Discovery, 4(2), 145–160. https://doi.org/10.1038/nrd1632
- Kummar, S., Chen, A. P., Wright, J., et al. (2007). Phase I study of oral etoposide in patients with advanced solid tumors. Clinical Cancer Research, 13(11), 3377–3383. https://doi.org/10.1158/1078-0432.CCR-06-2708
- Hande, K. R. (1998). Etoposide: Four decades of development of a topoisomerase II inhibitor. European Journal of Cancer, 34(10), 1514–1521. https://doi.org/10.1016/S0959-8049(98)00197-2
- Gabizon, A., et al. (2003). Pharmacokinetics of pegylated liposomal doxorubicin: Review of animal and human studies. Clinical Pharmacokinetics, 42(5), 419–436. https://doi.org/10.2165/00003088-200342050-00002
- Deshpande, P., Bisht, S., & Maitra, A. (2009). Evaluation of liposomal anticancer drug formulations. Current Opinion in Investigational Drugs, 10(12), 1334–1341.
- Allen, T. M., Hansen, C. B., de Menezes, D., et al. (1991). Liposomes containing synthetic lipid derivatives of poly(ethylene glycol) show prolonged circulation half-lives in vivo. Biochimica et Biophysica Acta (BBA) – Biomembranes, 1066(1), 29–36. https://doi.org/10.1016/0005-2736(91)90143-X
- Mozafari, M. R., Johnson, C., Hatziantoniou, S., & Demetzos, C. (2008). Nanoliposomes and their applications in food and pharmaceutical sectors. Journal of Liposome Research, 18(3), 309–327. https://doi.org/10.1080/08982100802335964
- Gelderblom, H., Verweij, J., Nooter, K., & Sparreboom, A. (2001). Cremophor EL: The drawbacks and advantages of vehicle selection for drug formulation. European Journal of Cancer, 37(13), 1590–1598. https://doi.org/10.1016/S0959-8049(01)00142-2
- Sparreboom, A., & Verweij, J. (1999). Pharmacokinetics of etoposide and determinants of oral bioavailability. Clinical Pharmacokinetics, 36(6), 447–460. https://doi.org/10.2165/00003088-199936060-00002
- McGuire, W. P., Hoskins, W. J., Brady, M. F., et al. (1996). Cyclophosphamide and etoposide in combination therapy. Journal of Clinical Oncology, 14(5), 1646–1655. https://doi.org/10.1200/JCO.1996.14.5.1646
- Harde, H., Das, M., & Jain, S. (2011). Liposomes: Preparation, characterization and applications. International Journal of Pharmaceutical Sciences Review and Research, 7(2), 1–8.
- Allen, T. M., & Cullis, P. R. (2013). Liposomal drug delivery systems: From concept to clinical applications. Advanced Drug Delivery Reviews, 65(1), 36–48. https://doi.org/10.1016/j.addr.2012.09.037
- Bozzuto, G., & Molinari, A. (2015). Liposomes as nanomedical devices. International Journal of Nanomedicine, 10, 975–999. https://doi.org/10.2147/IJN.S68861
- Torchilin, V. P. (2005). Recent advances with liposomes as pharmaceutical carriers. Nature Reviews Drug Discovery, 4(2), 145–160. https://doi.org/10.1038/nrd1632
- Immordino, M. L., Dosio, F., & Cattel, L. (2006). Stealth liposomes: Review of the basic science, rationale, and clinical applications. International Journal of Nanomedicine, 1(3), 297–315. https://doi.org/10.2147/nano.2006.1.3.297
- Kulkarni, A., & Feng, S. S. (2013). In vitro drug release from liposomes: Methods and kinetics. International Journal of Pharmaceutics, 458(1), 116–123. https://doi.org/10.1016/j.ijpharm.2013.09.015
- Deshpande, P., et al. (2009). Evaluation of liposomal anticancer drug formulations. Current Opinion in Investigational Drugs, 10(12), 1334–1341.
- Gabizon, A., Shmeeda, H., & Barenholz, Y. (2003). Pharmacokinetics of pegylated liposomal doxorubicin: Review of animal and human studies. Clinical Pharmacokinetics, 42(5), 419–436. https://doi.org/10.2165/00003088-200342050-00002
- Maeda, H. (2001). The enhanced permeability and retention (EPR) effect in tumor vasculature: The key for tumor-selective drug targeting. Advances in Enzyme Regulation, 41, 189–207. https://doi.org/10.1016/S0065-2571(00)00013-3
- Allen, T. M., Hansen, C. B., de Menezes, D., et al. (1991). Liposomes containing synthetic lipid derivatives of poly(ethylene glycol) show prolonged circulation half-lives in vivo. Biochimica et Biophysica Acta (BBA) – Biomembranes, 1066(1), 29–36. https://doi.org/10.1016/0005-2736(91)90143-X
- Mozafari, M. R., Johnson, C., Hatziantoniou, S., & Demetzos, C. (2008). Nanoliposomes and their applications in food and pharmaceutical sectors. Journal of Liposome Research, 18(3), 309–327. https://doi.org/10.1080/08982100802335964
- Akbarzadeh, A., et al. (2013). Liposome: Classification, preparation, and applications. Nanoscale Research Letters, 8, 102. https://doi.org/10.1186/1556-276X-8-102
- Patil, Y., & Jadhav, S. (2014). Liposomal drug delivery: A comprehensive review. International Journal of Pharmaceutical Research & Development, 6(11), 1–10.
- Gupta, A., & Kumar, P. (2010). Liposome drug delivery system: A review. Journal of Advanced Pharmaceutical Technology & Research, 1(4), 374–382. https://doi.org/10.4103/2231-4040.90790
- Shaji, J., & Patole, V. (2008). Protein and peptide drug delivery: Oral approaches. Indian Journal of Pharmaceutical Sciences, 70(3), 269–277. https://doi.org/10.4103/0250-474X.43017
- Harde, H., Das, M., & Jain, S. (2011). Liposomes: Preparation, characterization and applications. International Journal of Pharmaceutical Sciences Review and Research, 7(2), 1–8.
- Kulkarni, A., & Feng, S. S. (2013). In vitro drug release from liposomes: Methods and kinetics. International Journal of Pharmaceutics, 458(1), 116–123. https://doi.org/10.1016/j.ijpharm.2013.09.015
- Immordino, M. L., et al. (2006). Stealth liposomes: Review of the basic science, rationale, and clinical applications. International Journal of Nanomedicine, 1(3), 297–315. https://doi.org/10.2147/nano.2006.1.3.297
- Torchilin, V. P. (2005). Recent advances with liposomes as pharmaceutical carriers. Nature Reviews Drug Discovery, 4(2), 145–160. https://doi.org/10.1038/nrd1632
- Allen, T. M., & Cullis, P. R. (2013). Liposomal drug delivery systems: From concept to clinical applications. Advanced Drug Delivery Reviews, 65(1), 36–48. https://doi.org/10.1016/j.addr.2012.09.037
- Bozzuto, G., & Molinari, A. (2015). Liposomes as nanomedical devices. International Journal of Nanomedicine, 10, 975–999. https://doi.org/10.2147/IJN.S68861
- Gelderblom, H., Verweij, J., Nooter, K., & Sparreboom, A. (2001). Cremophor EL: The drawbacks and advantages of vehicle selection for drug formulation. European Journal of Cancer, 37(13), 1590–1598. https://doi.org/10.1016/S0959-8049(01)00142-2
- Sparreboom, A., & Verweij, J. (1999). Pharmacokinetics of etoposide and determinants of oral bioavailability. Clinical Pharmacokinetics, 36(6), 447–460. https://doi.org/10.2165/00003088-199936060-00002
- McGuire, W. P., Hoskins, W. J., Brady, M. F., et al. (1996). Cyclophosphamide and etoposide in combination therapy. Journal of Clinical Oncology, 14(5), 1646–1655. https://doi.org/10.1200/JCO.1996.14.5.1646
- Allen, T. M., & Cullis, P. R. (2013). Liposomal drug delivery systems: From concept to clinical applications. Advanced Drug Delivery Reviews, 65(1), 36–48. https://doi.org/10.1016/j.addr.2012.09.037
- Gabizon, A., Shmeeda, H., & Barenholz, Y. (2003). Pharmacokinetics of pegylated liposomal doxorubicin: Review of animal and human studies. Clinical Pharmacokinetics, 42(5), 419–436. https://doi.org/10.2165/00003088-200342050-00002
- Torchilin, V. P. (2005). Recent advances with liposomes as pharmaceutical carriers. Nature Reviews Drug Discovery, 4(2), 145–160. https://doi.org/10.1038/nrd1632
- Maeda, H., Wu, J., Sawa, T., Matsumura, Y., & Hori, K. (2000). Tumor vascular permeability and the EPR effect in macromolecular therapeutics: A review. Journal of Controlled Release, 65(1–2), 271–284. https://doi.org/10.1016/S0168-3659(99)00248-5
- Holohan, C., Van Schaeybroeck, S., Longley, D. B., & Johnston, P. G. (2013). Cancer drug resistance: An evolving paradigm. Nature Reviews Cancer, 13(10), 714–726. https://doi.org/10.1038/nrc3599
- Hande, K. R. (1998). Etoposide: Four decades of development of a topoisomerase II inhibitor. European Journal of Cancer, 34(10), 1514–1521. https://doi.org/10.1016/S0959-8049(98)00197-2
- Pommier, Y. (2006). Topoisomerase II inhibitors: Etoposide and beyond. Nature Reviews Cancer, 6(10), 789–802. https://doi.org/10.1038/nrc1977
- Kinghorn, A. D., & Pan, L. (2012). Etoposide: Chemistry and pharmacology. Natural Product Reports, 29(8), 967–988. https://doi.org/10.1039/c2np20035f
- Kummar, S., Chen, A. P., Wright, J., et al. (2007). Phase I study of oral etoposide in patients with advanced solid tumors. Clinical Cancer Research, 13(11), 3377–3383. https://doi.org/10.1158/1078-0432.CCR-06-2708
- Gelderblom, H., Verweij, J., Nooter, K., & Sparreboom, A. (2001). Cremophor EL: The drawbacks and advantages of vehicle selection for drug formulation. European Journal of Cancer, 37(13), 1590–1598. https://doi.org/10.1016/S0959-8049(01)00142-2
- Slater, E. P., & Folkman, J. (1984). Podophyllotoxin and derivatives as anticancer agents. Cancer Treatment Reviews, 11(3), 165–182. https://doi.org/10.1016/S0305-7372(84)80005-5
- Gewirtz, D. A. (1999). A critical evaluation of the mechanisms of action proposed for the antitumor effects of the anthracycline antibiotics. Biochemical Pharmacology, 57(7), 727–741. https://doi.org/10.1016/S0006-2952(98)00399-1
- Barenholz, Y. (2012). Doxil® — The first FDA-approved nano-drug: Lessons learned. Journal of Controlled Release, 160(2), 117–134. https://doi.org/10.1016/j.jconrel.2012.03.020.
Rushikesh Nirgude
Corresponding author
Matoshri College of Pharmacy, Eklahare, Nashik
Vedika Pagar
Co-author
Matoshri College of Pharmacy, Eklahare, Nashik
Ragini Kadvekar
Co-author
Matoshri College of Pharmacy, Eklahare, Nashik
Rushikesh Nirgude*, Vedika Pagar, Ragini Kadvekar, Formulation and Evaluation of Etoposide Liposomal Drug Delivery Systems, Int. J. Sci. R. Tech., 2025, 2 (10), 410-427. https://doi.org/10.5281/zenodo.17444421