Nanomedicines from the patient perspective - 30 years after PEGylated liposomal doxorubicin.

Thirty years after its landmark approval, PEGylated liposomal doxorubicin (PLD, Doxil®) remains one of the most influential examples of how drug delivery technologies can reshape cancer therapy. By altering the pharmacokinetics and tissue distribution of doxorubicin, PLD improved the tolerability of conventional anthracycline therapy to enable a more manageable treatment experience for patients. Despite these advantages, PLD demonstrated non-superior efficacy compared with free drug in select clinical trials, contributing to mixed perceptions regarding the clinical impact of nanomedicine platforms. In this Perspective, we revisit the clinical and translational legacy of PLD to examine nanomedicine's broader implications for oncology drug delivery. Using PLD as a case study, we discuss how translational gaps between preclinical promise and clinical performance have shaped perceptions of nanomedicine. We further highlight how conventional evaluation frameworks may undervalue important benefits delivered by nanotherapeutics. Improvements in tolerability and reductions in "time toxicity" - the time patients spend managing treatment and its consequences - are rarely quantified in clinical evaluation, suggesting that the value of nanomedicine platforms may be systematically underestimated within current clinical and reimbursement paradigms. Addressing this disconnect requires a broader framework for evaluating therapeutic benefit in oncology drug delivery. By reflecting on the experience of PLD, this Perspective argues for better integration of patient-centered outcomes when assessing nanomedicine technologies. In doing so, we aim to stimulate discussion on how the field can better align research priorities, clinical evaluation, and reimbursement considerations with the needs and experiences of patients.