Optimal targeting of PI3K-AKT and mTOR in advanced oestrogen receptor-positive breast cancer

The growing availability of targeted therapies for patients with advanced oestrogen receptor-positive breast cancer has improved survival, but there remains much to learn about the optimal management of these patients. The PI3K–AKT and mTOR pathways are among the most commonly activated pathways in...

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Bibliographic Details
Published in:The lancet oncology 2024-04, Vol.25 (4), p.e139-e151
Main Authors: Browne, Iseult M, André, Fabrice, Chandarlapaty, Sarat, Carey, Lisa A, Turner, Nicholas C
Format: Article
Language:English
Subjects:
1-Phosphatidylinositol 3-kinase
AKT protein
AKT1 protein
Breast cancer
Breast Neoplasms - drug therapy
Breast Neoplasms - genetics
Breast Neoplasms - metabolism
Cancer therapies
Chemotherapy
Class I Phosphatidylinositol 3-Kinases - genetics
Endocrine therapy
Estrogen receptors
Female
Humans
Kinases
Metabolism
Metastasis
Mutation
Phosphatidylinositol 3-Kinases - genetics
Phosphatidylinositol 3-Kinases - metabolism
Phosphorylation
Physiology
Plasma
Proto-Oncogene Proteins c-akt - genetics
PTEN protein
Receptors, Estrogen - genetics
TOR protein
TOR Serine-Threonine Kinases - genetics
TOR Serine-Threonine Kinases - metabolism
Tumors
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Summary:The growing availability of targeted therapies for patients with advanced oestrogen receptor-positive breast cancer has improved survival, but there remains much to learn about the optimal management of these patients. The PI3K–AKT and mTOR pathways are among the most commonly activated pathways in breast cancer, whose crucial role in the pathogenesis of this tumour type has spurred major efforts to target this pathway at specific kinase hubs. Approvals for oestrogen receptor-positive advanced breast cancer include the PI3K inhibitor alpelisib for PIK3CA-mutated tumours, the AKT inhibitor capivasertib for tumours with alterations in PIK3CA, AKT1, or PTEN, and the mTOR inhibitor everolimus, which is used irrespective of mutation status. The availability of different inhibitors leaves physicians with a potentially challenging decision over which of these therapies should be used for individual patients and when. In this Review, we present a comprehensive summary of our current understanding of the pathways and the three inhibitors and discuss strategies for the optimal sequencing of therapies in the clinic, particularly after progression on a CDK4/6 inhibitor.
ISSN:1470-2045
1474-5488
1474-5488
DOI:10.1016/S1470-2045(23)00676-9