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FA-HES-EPI/IMQ is a research-stage nanomedicine formulation designed for the intravesical chemoimmunotherapy of bladder cancer. It consists of folic acid-modified hydroxyethyl starch (FA-HES) conjugated to epirubicin (EPI) via an acid-sensitive hydrazone bond, forming a prodrug (FA-HES-EPI) that encapsulates the Toll-like receptor 7 (TLR7) agonist imiquimod (IMQ) within its hydrophobic core. This system forms micelles that target tumor cells via folate receptor-mediated endocytosis. Once internalized or within the acidic tumor microenvironment, the pH-responsive hydrazone bonds cleave, triggering the controlled release of both the chemotherapeutic epirubicin and the immunomodulator imiquimod. This dual-action approach aims to enhance tumor cell killing while repolarizing tumor-associated macrophages from an M2 to an M1 phenotype, thereby overcoming the immunosuppressive tumor microenvironment.
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