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**3**

*France* 

**The Airways: A Promising Route for the** 

*1INSERM U618, Université François Rabelais, Faculté de médecine, Tours* 

The outcome of lung cancer has not changed dramatically in recent years, despite the availability of new therapeutic agents. Lung cancer is the most common cause of cancerrelated death in all industrialised countries (28 % in the USA for 2009). It is usually treated by a combination of surgery, radiotherapy and chemotherapy; and anticancer drugs are generally given intravenously. But this delivery route leads to high drug concentrations in the systemic circulation, with some adverse side effects and low drug concentrations in the respiratory tract. Clearly, a new route for administering anti-cancer drugs is needed: the airways. Drugs for treating chronic respiratory diseases like asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis are commonly delivered *via* the airways. The main advantage of this route is that the drug is delivered directly into the bronchi, bronchioles or deep lungs. Airway delivery should theoretically ensure longer exposure of the intended target to higher concentrations of the drug, while reducing adverse side effects. The patient should therefore benefit from a minimum drug concentration in the bloodstream and other body tissues. The airways therefore appear to be an attractive route for delivering anticancer agents in lung cancer, especially when other treatments have limited success, and in particular pathological situations, such as bronchioloalveolar carcinoma (BAC). This chapter provides an overview of the delivery of anticancer agents by aerosoltherapy for treating lung cancers and metastases, including the current status in the

Effective drug delivery to the lungs *via* the airways requires a detailed knowledge of aerosols. The main parameters that should be considered are the particle size, the inspiratory flow rate, the volume of the inhalation and the calibre of the patient's airways. The model developed by Weibel divides the lungs into 23 serial branching generations. The first sixteen form the conducting bronchial airways and the last seven, the respiratory zone (or alveolar region) (Weibel et al., 1963). The lungs may also be divided in three parts, upper (apex), middle and lower (base). Thus the major challenge involved in delivering drugs into

**1. Introduction** 

**2.1 Aerosol deposition** 

use of aerosoltherapy in oncology and future progress.

**2. Challenge of aerosol drug delivery in lung cancer** 

the lungs is provided by the complex structure of the respiratory tract.

Guilleminault L.1,2, Hervé-Grépinet V.1, Lemarié E.1,2 and Heuzé-Vourc'h N.1

*2Service de Pneumologie, CHRU Tours* 

**Pulmonary Delivery of Anticancer Agents** 

