Nanomaterial (NM)
delivery to solid tumors has been the focus of
intense research for over a decade. Classically, scientists have tried
to improve NM delivery by employing passive or active targeting strategies,
making use of the so-called enhanced permeability and retention (EPR)
effect. This phenomenon is made possible due to the leaky tumor vasculature
through which NMs can leave the bloodstream, traverse through the
gaps in the endothelial lining of the vessels, and enter the tumor.
Recent studies have shown that despite many efforts to employ the
EPR effect, this process remains very poor. Furthermore, the role
of the EPR effect has been called into question, where it has been
suggested that NMs enter the tumor
via
active mechanisms
and not through the endothelial gaps. In this review, we provide a
short overview of the EPR and mechanisms to enhance it, after which
we focus on alternative delivery strategies that do not solely rely
on EPR in itself but can offer interesting pharmacological, physical,
and biological solutions for enhanced delivery. We discuss the strengths
and shortcomings of these different strategies and suggest combinatorial
approaches as the ideal path forward.