Hassan Ali, Aubel Corinne
INSERM, U1240 IMoST, Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, 63000 Clermont-Ferrand, France.
Département d'Oncogénétique, Laboratoire d'Oncologie Moléculaire, Centre Jean Perrin, 58 rue Montalembert, 63011 Clermont-Ferrand, France.
Cancers (Basel). 2025 Jul 3;17(13):2232. doi: 10.3390/cancers17132232.
Triple-negative breast cancer is the most aggressive subtype of breast cancer and is associated with the worst prognosis. Conventional chemotherapy remains the gold standard treatment for this disease but is associated with a high relapse rate, highlighting the urgent need for effective targeted therapies. The PI3K/Akt/mTOR pathway, dysregulated in nearly 60% of these cancers, appears to be a prime target. It involves a signaling cascade beginning with PI3K activation followed by activating phosphorylation of Akt and then mTOR complex, which activates oncogenic processes by enhancing protein synthesis, inhibiting apoptosis, dysregulating autophagy and promoting DNA repair that supports tumor cell survival. Moreover, the PI3K/Akt/mTOR pathway plays a central role in the development of chemoresistance. Numerous alterations (activating the mutation of PIK3CA or the loss of tumor suppressor PTEN) may lead to its overactivation. Targeted inhibitors of PI3K, Akt and mTOR have been developed to counteract this dysregulation. However, numerous cancer resistance mechanisms have emerged, reducing their efficacy, for example, reactivation of Akt following mTOR blockade, reactivation of the pathway by insulin signaling or activation of compensatory pathways such as the MAPK pathway, thus limiting their integration into routine practice. To counteract these resistances, combination therapies currently being investigated in clinical trials aim to improve clinical outcomes of PI3K/Akt/mTOR pathway inhibition. The aim of this review was to summarize current therapies developed to target this pathway in TNBC, with a focus on the resistance mechanisms that limit their effectiveness.
三阴性乳腺癌是乳腺癌中最具侵袭性的亚型,预后最差。传统化疗仍是该疾病的金标准治疗方法,但复发率高,这凸显了对有效靶向治疗的迫切需求。PI3K/Akt/mTOR通路在近60%的此类癌症中失调,似乎是一个主要靶点。它涉及一个信号级联反应,始于PI3K激活,随后是Akt的激活磷酸化,然后是mTOR复合物,通过增强蛋白质合成、抑制细胞凋亡、失调自噬和促进支持肿瘤细胞存活的DNA修复来激活致癌过程。此外,PI3K/Akt/mTOR通路在化疗耐药的发展中起核心作用。许多改变(PIK3CA的激活突变或肿瘤抑制因子PTEN的缺失)可能导致其过度激活。已开发出PI3K、Akt和mTOR的靶向抑制剂来对抗这种失调。然而,出现了许多癌症耐药机制,降低了它们的疗效,例如,mTOR阻断后Akt的重新激活、胰岛素信号通路对该通路的重新激活或补偿通路(如MAPK通路)的激活,从而限制了它们在常规治疗中的应用。为了对抗这些耐药性,目前正在临床试验中研究的联合疗法旨在改善PI3K/Akt/mTOR通路抑制的临床结果。本综述的目的是总结目前针对TNBC中该通路开发的治疗方法,重点关注限制其有效性的耐药机制。
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