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Precision nanomedicine in cancer: how far are we from personalization?

Nanotechnology has been continuously challenging the way we perceive diagnostics and therapy, and therefore impacting the way we diagnose, image, and treat cancer [1]. Novel concepts are continuously arising that show promise to deliver one or more treatment solutions to a specific type of cancer and doing so by simultaneously allowing visualization of the therapeutic effects [2,3]. These solutions have demonstrated the application of a multitude of nanoscale devices and platforms that make use of information retrieved from each subgroup of molecular biomarkers to direct treatment in a more precise and selective strategy. Such nanomedicines have changed the way we manage cancer by: (i) focusing on early detection of malignancy, even at the molecular level; (ii) new imaging schemes for real-time assessment of therapeutics; (iii) multifunctional therapeutics, where multiple functional/therapeutic moieties have been loaded into nanoscale devices to allow selective targeting, signaling, and delivery with improved precision and specificity to tumors; (iv) incorporating relevant biomarker information retrieved from the target patient onto the nanomedicine for personalization [4–6]. Precision nanomedicine has profited from the tremendous amount of information retrieved from big data screening that put forward selective biomarkers that allow focusing on a particular type of target [7]. In fact, most of the identified biomarkers have been used in the assembly of very specific and dedicated nanoscale devices, thus enhancing the precise targeting of a particular cell and/or tissue. Conversely, gathering the necessary data for these big data screening efforts has also profited from nanotechnology-designed molecular diagnostics that provide multiplexing and high throughput while reducing the amount of sample needed and associated costs [8]. Such endeavors have also allowed the identification of biomarkers before onset of disease, which in turn enhance the performance of prediction algorithms that evaluate risk and predisposition to cancer. It should also be referred that nanotechnology-based diagnostics have been developed toward point-of-care screening and analysis, thus shifting from invasive biopsies and traditional blood tests toward less invasive biological samples, e.g. saliva and urine. Nanomedicines used for theranostics (diagnostics and therapy) have relied on the remarkable properties conveyed by nanomaterials to provide more precise tracking of therapeutics and diagnostics within the body that can be accomplished with minimal invasion and using both standard and new disruptive approaches. Some of these nanotheranostics medicines may use the information retrieved from biomarker characterization and assortment to become active-response precise treatment solutions, i.e. responsive materials that react to a particular cell, tissue, and/or metabolic microenvironment to deliver treatment with improved precision. Two main strategies have been followed: (i) responsive conjugates that release the therapeutic cargo at selected precise locations as a response to sensing of the local environment (e.g. pHbased release, enzyme degradation of encapsulating formulation, etc.); or (ii) nanoscale carriers that can be imaged by the clinician who is then able to actuate upon them once they reach a precise site. Both show tremendous promise in the lab and their particular niches, but only but a few have been exposed to the real world and effectively transposed into the clinics [9,10].