siRNA clinical trials: state of the art With the emergence of siRNA-based nanomedicine as a powerful therapeutic strategy for cancers, seven of these therapeutics have now advanced to clinical trials. Carriers of siRNA therapeutics include transferrin-modified cyclodextrin (CALAA-01, Arrowhead Research Corporation, CA, USA), in vivo jetPEI (SNS01-T; Sevion Technologies, NJ, USA), cationic liposomes (ALN-VSP02, Alnylam Pharmaceuticals, MA, USA; TKM080301, Tekmira Pharmaceuticals, Burnaby, Canada; Atu027, Silence Therapeutics, London, UK; and DCRMYC, Dicerna Pharmaceuticals, Watertown, MA, USA) and neutral liposomes (siRNA–EphA2–1,2-dioleoyl-sn-glycero3-phosphocholine [DOPC], MD Anderson Cancer Center, TX, USA ). Among those in clinical trials, the cationic lipoplex targeting MYC1a (DCR-MYC) is the only nanoplex that requires the Dicer enzyme in order to obtain functional siRNA. In 2008, the transferrin-modified cyclodextrin polyplex (CALAA-01) was the first siRNA nanoparticle to be approved for cancer clinical trials. In a preclinical mouse study, a single dose of the cyclodextrin nanoplex targeting luciferase mRNA reduced its activity by 80% [1]. More importantly, melanoma patients receiving CALAA-01 in a Phase I clinical trial showed a 50–80% reduction in the RRM2 mRNA compared with mRNA from untreated tumor tissues [2]. Although this study showed promise, the development of CALAA-01 has been delayed and no results have been reported. SNS01-T is a polyethyleneimine (PEI)based (in vivo JetPEI) nanoparticle containing siRNAs targeting EIF5A and decoy plasmids expressing nonhypusinable eIF5A mutants for treatment of multiple myeloma and non-Hodgkin’s B-cell lymphoma [3]. Francis and colleagues have shown that SNS01-T enhances the antitumor efficacy of lenalidomide and bortezomib in a xenograft model [3]. An open-label, Phase I/II doseescalation study that includes 15 patients is currently underway. Sevion technologies, the manufacturer of SNS01-T, has reported no dose-limiting toxicities in four patients at a dose of 0.2 mg/kg of the nanoparticle. Cationic lipid nanoparticles (LNPs) have effectively downregulated oncogenes in malignant hepatomas (CDH16, PLK1, VEGF and MYC1a) and prostate tumors (PKN3) [4]. While LNPs have a circulation half-life that is longer than 18 h [5], most lipoplexes are ultimately internalized by the liver and spleen. Although the accumulation of lipoplexes may lead to tissue toxicity in these organs at higher dosages, they appear to be well-tolerated by humans at defined dosages. In Phase I clinical trials, the maximum tolerated doses were 0.336, 0.75 and 1.25 mg/kg for Atu027, TKM080301 and ALN-VSP02, respectively. As a result, LNPs targeting PKN3 (Atu027) and PLK1 (TKM080301) have been advanced to Phase II trials. Neutral DOPC liposomes have been used to target ovarian cancers (EPHA2, PTK2, and IL8) and melanoma (thrombin receptor) [6]. While siRNA–EphA2–DOPC inhibited tumor growth by approximately siRNA nanoparticles: the future of RNAi therapeutics for oncology?