The clinical need
for photodynamic therapy (PDT) has
been growing
for several decades. Notably, PDT is often used in oncology to treat
a variety of tumors since it is a low-risk therapy with excellent
selectivity, does not conflict with other therapies, and may be repeated
as necessary. The mechanism of action of PDT is the photoactivation
of a particular photosensitizer (PS) in a tumor microenvironment in
the presence of oxygen. During PDT, cancer cells produce singlet oxygen
(1O2) and reactive oxygen species (ROS) upon
activation of PSs by irradiation, which efficiently kills the tumor.
However, PDT’s effectiveness in curing a deep-seated malignancy
is constrained by three key reasons: a tumor’s inadequate PS
accumulation in tumor tissues, a hypoxic core with low oxygen content
in solid tumors, and limited depth of light penetration. PDTs are
therefore restricted to the management of thin and superficial cancers.
With the development of nanotechnology, PDT’s ability to penetrate
deep tumor tissues and exert desired therapeutic effects has become
a reality. However, further advancement in this field of research
is necessary to address the challenges with PDT and ameliorate the
therapeutic outcome. This review presents an overview of PSs, the
mechanism of loading of PSs, nanomedicine-based solutions for enhancing
PDT, and their biological applications including chemodynamic therapy,
chemo-photodynamic therapy, PDT–electroporation, photodynamic–photothermal
(PDT–PTT) therapy, and PDT–immunotherapy. Furthermore,
the review discusses the mechanism of ROS generation in PDT advantages
and challenges of PSs in PDT.