ArticleFrontiers in oncology2026
Nanomaterial-based strategies to overcome sorafenib resistance in hepatocellular carcinoma: from mechanistic insights to translational applications.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Hepatocellular carcinoma (HCC) is the most common histological subtype of primary liver cancer and a leading cause of cancer-related mortality. Although immunotherapy combinations have expanded systemic treatment options for advanced HCC, sorafenib remains clinically relevant in select patient populations and provides a mechanistically informative model for treatment resistance. Sorafenib resistance arises from interrelated processes, including insufficient intratumoral drug exposure, hypoxia-driven escape signaling, ABC transporter-mediated drug efflux, epithelial-mesenchymal transition, MAPK and PI3K/AKT/mTOR pathway compensation, ferroptosis dysregulation, and immunosuppressive microenvironment remodeling. Based on these mechanisms, we propose a mechanism-driven nanomedicine framework that integrates sorafenib delivery with targeted resistance-axis intervention, rather than focusing only on drug solubility, circulatory stability, or tumor accumulation. Representative strategies include ligand-targeted nanocarriers, CXCR4-directed delivery systems, the synchronous co-delivery of sorafenib with pathway inhibitors or nucleic acid regulators, ferroptosis-modulating nanodrugs, and tumor microenvironment (TME)-responsive delivery systems. Among these, biomimetic membrane-modified smart responsive platforms are particularly noteworthy because they can convert HCC microenvironmental features, such as elevated glutathione (GSH), immunosuppressive tumor-associated macrophage (TAM) accumulation, and ferroptosis resistance, into triggers for drug release, dual targeting, and resistance regulation. Artificial intelligence and machine learning may further support resistance-pattern prediction, patient stratification, nanoplatform selection, and formulation optimization. Overall, sorafenib nanomedicine may integrate drug delivery optimization, resistance intervention, and patient stratification into a unified therapeutic framework with improved mechanistic specificity and translational potential for sorafenib-resistant HCC.
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