Targeting the PI3K pathway in cancer: are we making headway?
Abstract
The PI3K-AKT-mTOR pathway is one of the most frequently dysregulated pathways in cancer and, consequently, more than 40 compounds that target key components of this signalling network have been tested in clinical trials involving patients with a range of different cancers. The clinical development of many of these agents, however, has not advanced to late-phase randomized trials, and the antitumour activity of those that have been evaluated in comparative prospective studies has typically been limited, or toxicities were found to be prohibitive. Nevertheless, the mTOR inhibitors temsirolimus and everolimus and the PI3K inhibitors idelalisib and copanlisib have been approved by the FDA for clinical use in the treatment of a number of different cancers. Novel compounds with greater potency and selectivity, as well as improved therapeutic indices owing to reduced risks of toxicity, are clearly required. In addition, biomarkers that are predictive of a response, such as PIK3CA mutations for inhibitors of the PI3K catalytic subunit α isoform, must be identified and analytically and clinically validated. Finally, considering that oncogenic activation of the PI3K-AKT-mTOR pathway often occurs alongside pro-tumorigenic aberrations in other signalling networks, rational combinations are also needed to optimize the effectiveness of treatment. Herein, we review the current experience with anticancer therapies that target the PI3K-AKT-mTOR pathway.
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The PI3K pathway is one of the most frequently dysregulated in cancer, and PI3Ks are studied as targets for cancer therapy.
“In addition to their diverse functions established in normal cells, PI3Ks are also quite extensively studied as targets for cancer therapy; the PI3K pathway is one of the most frequently dysregulated in cancer [71,72].”
From Phosphatidylinositol(4,5)bisphosphate: diverse functions at the plasma membrane (2020) · cites this paper as [71]
Everolimus (RAD001), an allosteric mTOR inhibitor, is approved by the FDA for numerous cancers such as advanced-stage renal cell carcinoma; in the phase III RECORD1 trial, everolimus was associated with prolonged progression-free survival in patients with advanced-stage RCC.
“Everolimus (RAD001), an allosteric mTOR inhibitor is another derivative of rapamycin approved by the FDA for the treatment of numerous cancers, such as advanced-stage renal cell carcinoma (RCC). In the phase III RECORD1 trial, everolimus was associated with prolonged progression-free survival (PFS) in patients with advanced-stage RCC [80].”
From Targeting KRAS mutant cancers: from druggable therapy to drug resistance (2022) · cites this paper as [80]
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- Authors
- Janku, F., Yap, T. A., & Meric-Bernstam, F.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- ORCID
- Yap, Timothy A.
- Venue
- Nature Reviews Clinical Oncology
- Published
- 2018-03-06
- Volume
- 15
- Issue
- 5
- Pages
- 273-291
- ISSN
- 1759-4774 (ISSN-L)
- 1759-4782
- OpenAlex
- W2789281724
- Cited by
- 1,033
- References
- 155
- Citations by year
- 2026: 52 · 2025: 88 · 2024: 121 · 2023: 119 · 2022: 169 · 2021: 145 · 2020: 171 · 2019: 123 · 2018: 44 · 2017: 1
- FWCI
- 11.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR000371)
- National Cancer Institute (P30CA016672)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › PI3K/AKT/mTOR signaling in cancer
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Advanced Breast Cancer Therapies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Keywords
- PI3K/AKT/mTOR pathway, PI3K inhibitors, mTOR inhibitors, temsirolimus, everolimus, idelalisib, copanlisib, PIK3CA mutation, predictive biomarkers, drug toxicity, combination therapy, carcinogenesis, anticancer drug development
- MeSH terms
- Everolimus, Humans, Neoplasms, Purines, Pyrimidines, Quinazolines, Signal Transduction, Oncogene Protein v-akt, Quinazolinones, Class I Phosphatidylinositol 3-Kinases, TOR Serine-Threonine Kinases, Molecular Targeted Therapy
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