Asnaghi Riccardo, Antonarelli Gabriele, Battaiotto Elena, Castellano Grazia, Guidi Lorenzo, Izzo Davide, Zagami Paola, Trapani Dario, Curigliano Giuseppe
Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Expert Opin Pharmacother. 2025 Feb;26(3):235-247. doi: 10.1080/14656566.2025.2454290. Epub 2025 Jan 27.
The PI3K pathway is crucial in breast cancer (BC), influencing cell survival, growth, and metabolism, with AKT playing a central role in treatment resistance. This pathway's involvement in breast carcinogenesis and its link to treatment resistance underscores the significance of targeting it in BC therapy. PI3K-pathway inhibitors offer new therapeutic avenues but bring challenges, especially due to toxicity issues that hinder their development.
This review discusses the PI3K-pathway inhibitors used in BC, highlighting emerging, innovative strategies.
The introduction of mTOR inhibitors marked a key step in tackling hormone receptor-positive (HR+) BC, targeting endocrine resistance. However, toxicity concerns remain, especially with PIK3CA and AKT inhibitors. Selective PI3K-targeted agents aim to reduce off-target toxicity, enhancing patient adherence and control over the disease. New compounds employing allosteric mechanisms may further limit adverse effects and allow safer combination therapies, previously limited by toxicity. Advancements in dosing strategies focus on patient-centered outcomes, and synergistic agents are essential in advancing AKT-pathway inhibition, paving the way for a new phase in HR+ BC treatment.
PI3K通路在乳腺癌(BC)中至关重要,影响细胞存活、生长和代谢,AKT在治疗耐药中起核心作用。该通路参与乳腺癌发生及其与治疗耐药的联系凸显了在BC治疗中靶向该通路的重要性。PI3K通路抑制剂提供了新的治疗途径,但也带来了挑战,尤其是由于毒性问题阻碍了它们的发展。
本综述讨论了用于BC的PI3K通路抑制剂,强调了新兴的创新策略。
mTOR抑制剂的引入是应对激素受体阳性(HR+)BC、靶向内分泌耐药的关键一步。然而,毒性问题仍然存在,尤其是PIK3CA和AKT抑制剂。选择性PI3K靶向药物旨在降低脱靶毒性,提高患者依从性并增强对疾病的控制。采用变构机制的新化合物可能进一步限制不良反应,并允许进行以前受毒性限制的更安全的联合治疗。给药策略的进展侧重于以患者为中心的结果,协同药物对于推进AKT通路抑制至关重要,为HR+ BC治疗的新阶段铺平道路。