Topical application of liposomes containing cetuximab: effect of physical methods for skin penetration in skin squamous cell carcinoma

Squamous cell carcinoma (SCC) is a malignant tumor of epithelial origin in which the epidermal growth factor receptor (EGFR) is overexpressed and associated with malignization. Cetuximab is a monoclonal antibody, able to selectively bind EGFR. The combination of the chemotherapy with the hydrophilic drug 5-fluorouracil (5- FU) and cetuximab is applied in the clinic by intravenous injection and is associated with side effects. Cetuximab conjugation onto liposomal surface, which can be administered topically onto the skin using physical methods, such as iontophoresis, is able to direct 5-FU release to the skin layers where tumors are localized and to increase cellular uptake in EGFR positive cells, making possible the topical treatment of SCC. Thus, the objective of this work was to investigate the influence of cetuximab conjugation to liposomes (immunoliposomes) in the passive and iontophoresis skin penetration of 5-FU and SCC regression. For this purpose, an analytical and a bioanalytical method were developed and validated for 5-FU quantification. Then, conventional liposomes were prepared using different lipid compositions, preparation methods and drug to lipid ratios in order to select those able to load higher percentages of 5-FU. Liposomes composed by 1,2-Distearoylsn- glycero-3-phosphocholine and cholesterol (DSPC:Chol, 55:45) prepared by the thin lipid film hydration with drug/lipid ratio 0.1 with approximately 140 nm, were chosen because they encapsulated about 50% of 5-FU. For the obtainment of immunoliposomes, cetuximab was first coupled to the lipid DSPE linked to maleimide (polyethylene glycol)-2000 (DSPE-PEG-Mal) as an anchor for the antibody conjugation, resulting in 94% coupling efficiency. The immunoliposomes were obtained similarly to liposomes, with similar particle size and loading efficiency of 5-FU. In vitro studies using EGFR positive cells (A431) showed synergism for 5-FU and cetuximab, resulting in IC50 values about 3 times lower than 5-FU solution. Cellular uptake of immunoliposomes increased 3.5-fold compared to the liposomes. In vitro skin penetration studies revealed that, compared to the 5-FU solution, liposomes and immunoliposomes reduced the amount of 5-FU that passed through the skin. Iontophoresis increased the amount of 5-FU retained in viable epidermis for all formulations. In this case, the amount of 5-FU in viable epidermis, where tumors are localized, was 2 times higher when it was encapsulated in immunoliposomes compared to liposomes. In vivo, the formulations were administered subcutaneously or topically with iontophoresis in xenograft animal model of SCC. Treatment with immunoliposomes reduced tumor growth more than 60% compared to the negative control and about 50% compared to the treatments with 5-FU solution and liposomes. The topical administration using iontophoresis resulted in improved tumor reduction compared to the subcutaneous administration when tumors were treated with 5-FU solution and liposomes, but was equally effective for the immunoliposomes. The histological analysis showed the reduction of cellular proliferation for the treated groups. In conclusion, the administration of immunoliposomes containing 5-FU using iontophoresis is a promising strategy for the topical treatment of SCC (AU)