PI3K/AKT/mTOR信号通路与乳腺癌多药耐药性研究进展
Research Progress on PI3K/AKT/mTOR Signaling Pathway and Multidrug Resistance in Breast Cancer
DOI: 10.12677/hjbm.2025.152039, PDF,    国家自然科学基金支持
作者: 陈鸿艳*:昆明医科大学药学院暨云南省天然药物药理重点实验室,云南 昆明;周宏宇#:昆明医科大学药学院暨云南省天然药物药理重点实验室,云南 昆明;昆明医科大学现代生物医药产业学院,云南 昆明
关键词: 乳腺癌PI3K/AKT/mTOR信号通路多药耐药抑制剂Breast Cancer PI3K/AKT/mTOR Signaling Pathway Multidrug Resistance Inhibitors
摘要: 乳腺癌多药耐药是导致乳腺癌治疗失败的主要原因。PI3K/AKT/mTOR信号通路异常激活与乳腺癌的发生发展及耐药性密切相关,抑制该通路是改善乳腺癌治疗效果和克服耐药的可行途径。目前,许多PI3K/AKT/mTOR信号通路抑制剂通过联合标准疗法克服乳腺癌的多药耐药正处于临床前或临床研究。本文综述了PI3K/AKT/mTOR通路在乳腺癌多药耐药中的作用以及通过抑制该通路克服乳腺癌多药耐药的策略研究。
Abstract: Multidrug resistance of breast cancer is the main cause of treatment failure of breast cancer. The abnormal activation of PI3K/AKT/mTOR signaling pathway is closely related to the occurrence, development and drug resistance of breast cancer. Inhibiting PI3K/AKT/mTOR signaling pathway is an effective way to improve the therapeutic effect of breast cancer and overcome drug resistance. At present, several PI3K/AKT/mTOR signaling pathway inhibitors are in preclinical or clinical research to overcome multidrug resistance of breast cancer. This article reviews the role of PI3K/AKT/mTOR pathway in breast cancer multidrug resistance and the research progress of strategies to overcome breast cancer multidrug resistance by inhibiting this pathway.
文章引用:陈鸿艳, 周宏宇. PI3K/AKT/mTOR信号通路与乳腺癌多药耐药性研究进展[J]. 生物医学, 2025, 15(2): 328-338. https://doi.org/10.12677/hjbm.2025.152039

参考文献

[1] Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R.L., Soerjomataram, I., et al. (2024) Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 74, 229-263. [Google Scholar] [CrossRef] [PubMed]
[2] Gradishar, W.J., Moran, M.S., Abraham, J., Abramson, V., Aft, R., Agnese, D., et al. (2023) NCCN Guidelines Insights: Breast Cancer, Version 4.2023. Journal of the National Comprehensive Cancer Network, 21, 594-608. [Google Scholar] [CrossRef] [PubMed]
[3] Videira, M., Reis, R.L. and Brito, M.A. (2014) Deconstructi ng Breast Cancer Cell Biology and the Mechanisms of Multidrug Resistance. Biochimica et Biophysica ActaReviews on Cancer, 1846, 312-325. [Google Scholar] [CrossRef] [PubMed]
[4] Vivanco, I. and Sawyers, C.L. (2002) The Phosphatidylinositol 3-Kinase-AKT Pathway in Human Cancer. Nature Reviews Cancer, 2, 489-501. [Google Scholar] [CrossRef] [PubMed]
[5] Manning, B.D. and Cantley, L.C. (2007) AKT/PKB Signaling: Navigating Downstream. Cell, 129, 1261-1274. [Google Scholar] [CrossRef] [PubMed]
[6] Zhang, M., Jang, H. and Nussinov, R. (2019) The Mechanism of PI3Kα Activation at the Atomic Level. Chemical Science, 10, 3671-3680. [Google Scholar] [CrossRef] [PubMed]
[7] Brognard, J., Sierecki, E., Gao, T. and Newton, A.C. (2007) PHLPP and a Second Isoform, PHLPP2, Differentially Attenuate the Amplitude of Akt Signaling by Regulating Distinct Akt Isoforms. Molecular Cell, 25, 917-931. [Google Scholar] [CrossRef] [PubMed]
[8] Lu, Y., Yu, M., Jia, Y., Yang, F., Zhang, Y., Xu, X., et al. (2022) Structural Basis for the Activity Regulation of a Potassium Channel AKT1 from Arabidopsis. Nature Communications, 13, Article No. 5682. [Google Scholar] [CrossRef] [PubMed]
[9] Fattahi, S., Amjadi-Moheb, F., Tabaripour, R., Ashrafi, G.H. and Akhavan-Niaki, H. (2020) PI3K/Akt/mTOR Signaling in Gastric Cancer: Epigenetics and Beyond. Life Sciences, 262, Article 118513. [Google Scholar] [CrossRef] [PubMed]
[10] Tan, A.C. (2020) Targeting the PI3K/Akt/mTOR Pathway in Non-Small Cell Lung Cancer (NSCLC). Thoracic Cancer, 11, 511-518. [Google Scholar] [CrossRef] [PubMed]
[11] Ediriweera, M.K., Tennekoon, K.H. and Samarakoon, S.R. (2019) Role of the PI3K/Akt/mTOR Signaling Pathway in Ovarian Cancer: Biological and Therapeutic Significance. Seminars in Cancer Biology, 59, 147-160. [Google Scholar] [CrossRef] [PubMed]
[12] Browne, I.M., André, F., Chandarlapaty, S., Carey, L.A. and Turner, N.C. (2024) Optimal Targeting of PI3K-AKT and mTOR in Advanced Oestrogen Receptor-Positive Breast Cancer. The Lancet Oncology, 25, e139-e151. [Google Scholar] [CrossRef] [PubMed]
[13] Stefani, C., Miricescu, D., Stanescu-Spinu, I., Nica, R.I., Greabu, M., Totan, A.R., et al. (2021) Growth Factors, PI3K/Akt/mTOR and MAPK Signaling Pathways in Colorectal Cancer Pathogenesis: Where Are We Now? International Journal of Molecular Sciences, 22, Article 10260. [Google Scholar] [CrossRef] [PubMed]
[14] Glaviano, A., Foo, A.S.C., Lam, H.Y., Yap, K.C.H., Jacot, W., Jones, R.H., et al. (2023) PI3K/Akt/mTOR Signaling Transduction Pathway and Targeted Therapies in Cancer. Molecular Cancer, 22, Article No. 138. [Google Scholar] [CrossRef] [PubMed]
[15] Gelmon, K., Dent, R., Mackey, J.R., Laing, K., McLeod, D. and Verma, S. (2012) Targeting Triple-Negative Breast Cancer: Optimising Therapeutic Outcomes. Annals of Oncology, 23, 2223-2234. [Google Scholar] [CrossRef] [PubMed]
[16] Nunnery, S.E. and Mayer, I.A. (2020) Targeting the PI3K/Akt/mTOr Pathway in Hormone-Positive Breast Cancer. Drugs, 80, 1685-1697. [Google Scholar] [CrossRef] [PubMed]
[17] Pan, L., Li, J., Xu, Q., Gao, Z., Yang, M., Wu, X., et al. (2024) HER2/PI3K/AKT Pathway in Her2-Positive Breast Cancer: A Review. Medicine, 103, e38508. [Google Scholar] [CrossRef] [PubMed]
[18] Bertucci, A., Bertucci, F. and Gonçalves, A. (2023) Phosphoinositide 3-Kinase (PI3K) Inhibitors and Breast Cancer: An Overview of Current Achievements. Cancers, 15, Article 1416. [Google Scholar] [CrossRef] [PubMed]
[19] LoRusso, P.M. (2016) Inhibition of the PI3K/Akt/mTOR Pathway in Solid Tumors. Journal of Clinical Oncology, 34, 3803-3815. [Google Scholar] [CrossRef] [PubMed]
[20] Fritsch, C., Huang, A., Chatenay-Rivauday, C., Schnell, C., Reddy, A., Liu, M., et al. (2014) Characterization of the Novel and Specific PI3Kα Inhibitor NVP-BYL719 and Development of the Patient Stratification Strategy for Clinical Trials. Molecular Cancer Therapeutics, 13, 1117-1129. [Google Scholar] [CrossRef] [PubMed]
[21] Juric, D., Rodon, J., Tabernero, J., Janku, F., Burris, H.A., Schellens, J.H.M., et al. (2018) Phosphatidylinositol 3-Kinase Α-Selective Inhibition with Alpelisib (BYL719) in PIK3CA-Altered Solid Tumors: Results from the First-in-Human Study. Journal of Clinical Oncology, 36, 1291-1299. [Google Scholar] [CrossRef] [PubMed]
[22] Juric, D., Krop, I., Ramanathan, R.K., Wilson, T.R., Ware, J.A., Sanabria Bohorquez, S.M., et al. (2017) Phase I Dose-Escalation Study of Taselisib, an Oral PI3K Inhibitor, in Patients with Advanced Solid Tumors. Cancer Discovery, 7, 704-715. [Google Scholar] [CrossRef] [PubMed]
[23] Sarker, D., Ang, J.E., Baird, R., Kristeleit, R., Shah, K., Moreno, V., et al. (2015) First-in-Human Phase I Study of Pictilisib (GDC-0941), a Potent Pan-Class I Phosphatidylinositol-3-Kinase (PI3K) Inhibitor, in Patients with Advanced Solid Tumors. Clinical Cancer Research, 21, 77-86. [Google Scholar] [CrossRef] [PubMed]
[24] Ando, Y., Inada-Inoue, M., Mitsuma, A., Yoshino, T., Ohtsu, A., Suenaga, N., et al. (2014) Phase I Dose-Escalation Study of Buparlisib (BKM120), an Oral Pan-Class I PI3K Inhibitor, in Japanese Patients with Advanced Solid Tumors. Cancer Science, 105, 347-353. [Google Scholar] [CrossRef] [PubMed]
[25] Maira, S., Stauffer, F., Brueggen, J., Furet, P., Schnell, C., Fritsch, C., et al. (2008) Identification and Characterization of NVP-BEZ235, a New Orally Available Dual Phosphatidylinositol 3-Kinase/Mammalian Target of Rapamycin Inhibitor with Potent in Vivo Antitumor Activity. Molecular Cancer Therapeutics, 7, 1851-1863. [Google Scholar] [CrossRef] [PubMed]
[26] Nitulescu, G.M., Margina, D., Juzenas, P., Peng, Q., Olaru, O.T., Saloustros, E., et al. (2015) Akt Inhibitors in Cancer Treatment: The Long Journey from Drug Discovery to Clinical Use (Review). International Journal of Oncology, 48, 869-885. [Google Scholar] [CrossRef] [PubMed]
[27] Mohd Sharial, M.S.N., Crown, J. and Hennessy, B.T. (2012) Overcoming Resistance and Restoring Sensitivity to Her2-Targeted Therapies in Breast Cancer. Annals of Oncology, 23, 3007-3016. [Google Scholar] [CrossRef] [PubMed]
[28] Baselga, J., Campone, M., Piccart, M., Burris, H.A., Rugo, H.S., Sahmoud, T., et al. (2012) Everolimus in Postmenopausal Hormone-Receptor-Positive Advanced Breast Cancer. New England Journal of Medicine, 366, 520-529. [Google Scholar] [CrossRef] [PubMed]
[29] Decker, T., Söling, U., Hahn, A., Maintz, C., Kurbacher, C.M., Vehling-Kaiser, U., et al. (2020) Final Results from IMPROVE: A Randomized, Controlled, Open-Label, Two-Arm, Cross-Over Phase IV Study to Determine Patients’ Preference for Everolimus in Combination with Exemestane or Capecitabine in Combination with Bevacizumab in Advanced HR-Positive, Her2-Negative Breast Cancer. BMC Cancer, 20, Article No. 286. [Google Scholar] [CrossRef] [PubMed]
[30] Cook, M.M., Al Rabadi, L., Kaempf, A.J., Saraceni, M.M., Savin, M.A. and Mitri, Z.I. (2020) Everolimus Plus Exemestane Treatment in Patients with Metastatic Hormone Receptor-Positive Breast Cancer Previously Treated with CDK4/6 Inhibitor Therapy. The Oncologist, 26, 101-106. [Google Scholar] [CrossRef] [PubMed]
[31] Wolff, A.C., Lazar, A.A., Bondarenko, I., Garin, A.M., Brincat, S., Chow, L., et al. (2013) Randomized Phase III Placebo-Controlled Trial of Letrozole Plus Oral Temsirolimus as First-Line Endocrine Therapy in Postmenopausal Women with Locally Advanced or Metastatic Breast Cancer. Journal of Clinical Oncology, 31, 195-202. [Google Scholar] [CrossRef] [PubMed]
[32] Guerrero-Zotano, A., Mayer, I.A. and Arteaga, C.L. (2016) PI3K/Akt/mTOR: Role in Breast Cancer Progression, Drug Resistance, and Treatment. Cancer and Metastasis Reviews, 35, 515-524. [Google Scholar] [CrossRef] [PubMed]
[33] Miranda, F., Prazeres, H., Mendes, F., Martins, D. and Schmitt, F. (2021) Resistance to Endocrine Therapy in HR and/or HER2+ Breast Cancer: The Most Promising Predictive Biomarkers. Molecular Biology Reports, 49, 717-733. [Google Scholar] [CrossRef] [PubMed]
[34] Zou, Z., Zhang, J., Zhang, H., Liu, H., Li, Z., Cheng, D., et al. (2014) 3-Methyladenine Can Depress Drug Efflux Transporters via Blocking the PI3K-Akt-mTOR Pathway Thus Sensitizing MDR Cancer to Chemotherapy. Journal of Drug Targeting, 22, 839-848. [Google Scholar] [CrossRef] [PubMed]
[35] Beelen, K., Hoefnagel, L.D.C., Opdam, M., Wesseling, J., Sanders, J., Vincent, A.D., et al. (2014) PI3K/Akt/mTOR Pathway Activation in Primary and Corresponding Metastatic Breast Tumors after Adjuvant Endocrine Therapy. International Journal of Cancer, 135, 1257-1263. [Google Scholar] [CrossRef] [PubMed]
[36] Campbell, R.A., Bhat-Nakshatri, P., Patel, N.M., Constantinidou, D., Ali, S. and Nakshatri, H. (2001) Phosphatidylinositol 3-Kinase/Akt-Mediated Activation of Estrogen Receptor Α. Journal of Biological Chemistry, 276, 9817-9824. [Google Scholar] [CrossRef] [PubMed]
[37] Li, D., Ji, H., Niu, X., Yin, L., Wang, Y., Gu, Y., et al. (2019) Tumor-Associated Macrophages Secrete CC-Chemokine Ligand 2 and Induce Tamoxifen Resistance by Activating PI3K/Akt/mTOR in Breast Cancer. Cancer Science, 111, 47-58. [Google Scholar] [CrossRef] [PubMed]
[38] Sanchez, C.G., Ma, C.X., Crowder, R.J., Guintoli, T., Phommaly, C., Gao, F., et al. (2011) Preclinical Modeling of Combined Phosphatidylinositol-3-Kinase Inhibition with Endocrine Therapy for Estrogen Receptor-Positive Breast Cancer. Breast Cancer Research, 13, R21. [Google Scholar] [CrossRef] [PubMed]
[39] Cavazzoni, A., Bonelli, M.A., Fumarola, C., La Monica, S., Airoud, K., Bertoni, R., et al. (2012) Overcoming Acquired Resistance to Letrozole by Targeting the PI3K/Akt/mTOR Pathway in Breast Cancer Cell Clones. Cancer Letters, 323, 77-87. [Google Scholar] [CrossRef] [PubMed]
[40] Piccart, M., Hortobagyi, G.N., Campone, M., Pritchard, K.I., Lebrun, F., Ito, Y., et al. (2014) Everolimus Plus Exemestane for Hormone-Receptor-Positive, Human Epidermal Growth Factor Receptor-2-Negative Advanced Breast Cancer: Overall Survival Results from Bolero-2. Annals of Oncology, 25, 2357-2362. [Google Scholar] [CrossRef] [PubMed]
[41] Bachelot, T., Bourgier, C., Cropet, C., Guastalla, J., Ferrero, J., Leger-Falandry, C., et al. (2010) Abstract S1-6: TAMRAD: A GINECO Randomized Phase II Trial of Everolimus in Combination with Tamoxifen versus Tamoxifen Alone in Patients (pts) with Hormone-Receptor Positive, HER2 Negative Metastatic Breast Cancer (MBC) with Prior Exposure to Aromatase Inhibitors (AI). Cancer Research, 70, S1-S6. [Google Scholar] [CrossRef
[42] Baselga, J., Im, S., Iwata, H., Cortés, J., De Laurentiis, M., Jiang, Z., et al. (2017) Buparlisib Plus Fulvestrant versus Placebo Plus Fulvestrant in Postmenopausal, Hormone Receptor-Positive, Her2-Negative, Advanced Breast Cancer (BELLE-2): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial. The Lancet Oncology, 18, 904-916. [Google Scholar] [CrossRef] [PubMed]
[43] Jones, R.H., Casbard, A., Carucci, M., Cox, C., Butler, R., Alchami, F., et al. (2020) Fulvestrant Plus Capivasertib versus Placebo after Relapse or Progression on an Aromatase Inhibitor in Metastatic, Oestrogen Receptor-Positive Breast Cancer (FAKTION): A Multicentre, Randomised, Controlled, Phase 2 Trial. The Lancet Oncology, 21, 345-357. [Google Scholar] [CrossRef] [PubMed]
[44] Saura, C., Hlauschek, D., Oliveira, M., Zardavas, D., Jallitsch-Halper, A., de la Peña, L., et al. (2019) Neoadjuvant Letrozole Plus Taselisib versus Letrozole Plus Placebo in Postmenopausal Women with Oestrogen Receptor-Positive, Her2-Negative, Early-Stage Breast Cancer (LORELEI): A Multicentre, Randomised, Double-Blind, Placebo-Controlled, Phase 2 Trial. The Lancet Oncology, 20, 1226-1238. [Google Scholar] [CrossRef] [PubMed]
[45] Maji, S., Panda, S., Samal, S.K., Shriwas, O., Rath, R., Pellecchia, M., et al. (2018) BCL-2 Antiapoptotic Family Proteins and Chemoresistance in Cancer. In: Advances in Cancer Research, Elsevier, 37-75. [Google Scholar] [CrossRef] [PubMed]
[46] Higgins, C.F. (2007) Multiple Molecular Mechanisms for Multidrug Resistance Transporters. Nature, 446, 749-757. [Google Scholar] [CrossRef] [PubMed]
[47] Zhu, Y., Liu, Y., Zhang, C., Chu, J., Wu, Y., Li, Y., et al. (2018) Tamoxifen-Resistant Breast Cancer Cells Are Resistant to DNA-Damaging Chemotherapy Because of Upregulated BARD1 and BRCA1. Nature Communications, 9, Article No. 1595. [Google Scholar] [CrossRef] [PubMed]
[48] Li, Y., Weng, H., Hsu, J., Lin, S., Guh, J. and Hsu, L. (2019) The Combination of MK-2206 and WZB117 Exerts a Synergistic Cytotoxic Effect against Breast Cancer Cells. Frontiers in Pharmacology, 10, Article 1311. [Google Scholar] [CrossRef] [PubMed]
[49] Hu, Y., Guo, R., Wei, J., Zhou, Y., Ji, W., Liu, J., et al. (2015) Effects of PI3K Inhibitor NVP-BKM120 on Overcoming Drug Resistance and Eliminating Cancer Stem Cells in Human Breast Cancer Cells. Cell Death & Disease, 6, e2020-e2020. [Google Scholar] [CrossRef] [PubMed]
[50] Loibl, S., de la Pena, L., Nekljudova, V., Zardavas, D., Michiels, S., Denkert, C., et al. (2017) Neoadjuvant Buparlisib Plus Trastuzumab and Paclitaxel for Women with HER2+ Primary Breast Cancer: A Randomised, Double-Blind, Placebo-Controlled Phase II Trial (Neophoebe). European Journal of Cancer, 85, 133-145. [Google Scholar] [CrossRef] [PubMed]
[51] Kim, S., Dent, R., Im, S., Espié, M., Blau, S., Tan, A.R., et al. (2017) Ipatasertib Plus Paclitaxel versus Placebo Plus Paclitaxel as First-Line Therapy for Metastatic Triple-Negative Breast Cancer (LOTUS): A Multicentre, Randomised, Double-Blind, Placebo-Controlled, Phase 2 Trial. The Lancet Oncology, 18, 1360-1372. [Google Scholar] [CrossRef] [PubMed]
[52] Wu, X., Yang, H., Yu, X. and Qin, J. (2022) Drug-Resistant HER2-Positive Breast Cancer: Molecular Mechanisms and Overcoming Strategies. Frontiers in Pharmacology, 13, Article 1012552. [Google Scholar] [CrossRef] [PubMed]
[53] Dey, N., Williams, C., Leyland-Jones, B. and De, P. (2015) A Critical Role for HER3 in HER2-Amplified and Non-Amplified Breast Cancers: Function of a Kinase-Dead RTK. American Journal of Translational Research, 7, 733-750.
[54] Fujimoto, Y., Morita, T.Y., Ohashi, A., Haeno, H., Hakozaki, Y., Fujii, M., et al. (2020) Combination Treatment with a PI3K/Akt/mTOR Pathway Inhibitor Overcomes Resistance to Anti-HER2 Therapy in PIK3CA-Mutant HER2-Positive Breast Cancer Cells. Scientific Reports, 10, Article No. 21762. [Google Scholar] [CrossRef] [PubMed]
[55] Maira, S., Pecchi, S., Huang, A., Burger, M., Knapp, M., Sterker, D., et al. (2012) Identification and Characterization of NVP-BKM120, an Orally Available Pan-Class I PI3-Kinase Inhibitor. Molecular Cancer Therapeutics, 11, 317-328. [Google Scholar] [CrossRef] [PubMed]
[56] García-García, C., Ibrahim, Y.H., Serra, V., Calvo, M.T., Guzmán, M., Grueso, J., et al. (2012) Dual Mtorc1/2 and HER2 Blockade Results in Antitumor Activity in Preclinical Models of Breast Cancer Resistant to Anti-HER2 Therapy. Clinical Cancer Research, 18, 2603-2612. [Google Scholar] [CrossRef] [PubMed]
[57] Brünner-Kubath, C., Shabbir, W., Saferding, V., Wagner, R., Singer, C.F., Valent, P., et al. (2010) The PI3 Kinase/mTOR Blocker NVP-BEZ235 Overrides Resistance against Irreversible ErbB Inhibitors in Breast Cancer Cells. Breast Cancer Research and Treatment, 129, 387-400. [Google Scholar] [CrossRef] [PubMed]
[58] Hurvitz, S.A., Andre, F., Jiang, Z., Shao, Z., Mano, M.S., Neciosup, S.P., et al. (2015) Combination of Everolimus with Trastuzumab Plus Paclitaxel as First-Line Treatment for Patients with HER2-Positive Advanced Breast Cancer (BOLERO-1): A Phase 3, Randomised, Double-Blind, Multicentre Trial. The Lancet Oncology, 16, 816-829. [Google Scholar] [CrossRef] [PubMed]
[59] Isaacs, C., Ozguroglu, M., Jerusalem, G., Xu, B., Láng, I., O'Regan, R., et al. (2013) Abstract P4-12-18: BOLERO-3: Quality-of-Life Maintained in Patients with Metastatic Breast Cancer Treated with Everolimus Plus Trastuzumab Plus Vinorelbine. Cancer Research, 73, P4-12-18. [Google Scholar] [CrossRef
[60] Gianni, L., Pienkowski, T., Im, Y., Tseng, L., Liu, M., Lluch, A., et al. (2016) 5-Year Analysis of Neoadjuvant Pertuzumab and Trastuzumab in Patients with Locally Advanced, Inflammatory, or Early-Stage HER2-Positive Breast Cancer (Neosphere): A Multicentre, Open-Label, Phase 2 Randomised Trial. The Lancet Oncology, 17, 791-800. [Google Scholar] [CrossRef] [PubMed]
[61] Cortesi, L., Rugo, H.S. and Jackisch, C. (2021) An Overview of PARP Inhibitors for the Treatment of Breast Cancer. Targeted Oncology, 16, 255-282. [Google Scholar] [CrossRef] [PubMed]
[62] Menezes, M., Raheem, F., Mina, L., Ernst, B. and Batalini, F. (2022) PARP Inhibitors for Breast Cancer: Germline BRCA1/2 and beyond. Cancers, 14, Article 4332. [Google Scholar] [CrossRef] [PubMed]
[63] Li, H., Liu, Z., Wu, N., Chen, Y., Cheng, Q. and Wang, J. (2020) PARP Inhibitor Resistance: The Underlying Mechanisms and Clinical Implications. Molecular Cancer, 19, Article No. 107. [Google Scholar] [CrossRef] [PubMed]
[64] De, P., Sun, Y., Carlson, J.H., Friedman, L.S., Leyland-Jones, B.R. and Dey, N. (2014) Doubling down on the PI3K-Akt-mTOR Pathway Enhances the Antitumor Efficacy of PARP Inhibitor in Triple Negative Breast Cancer Model Beyond BRCA-Ness. Neoplasia, 16, 43-W19. [Google Scholar] [CrossRef] [PubMed]
[65] Tapodi, A., Bognar, Z., Szabo, C., Gallyas, F., Sumegi, B. and Hocsak, E. (2019) PARP Inhibition Induces Akt-Mediated Cytoprotective Effects through the Formation of a Mitochondria-Targeted Phospho-Atm-Nemo-Akt-mTOR Signalosome. Biochemical Pharmacology, 162, 98-108. [Google Scholar] [CrossRef] [PubMed]
[66] Tai, Y., Chow, A., Han, S., Coker, C., Ma, W., Gu, Y., et al. (2024) FLT1 Activation in Cancer Cells Promotes Parp-Inhibitor Resistance in Breast Cancer. EMBO Molecular Medicine, 16, 1957-1980. [Google Scholar] [CrossRef] [PubMed]
[67] Liu, Z., Zuo, T., Xu, F. and Xu, P. (2021) CDK4/6 Signaling Pathway and Its Targeted Therapeutic Agents in Cancer Therapy: A Review. Chinese Journal of Biotechnology, 37, 2232-2239.
[68] 刘子齐, 左涛, 徐锋, 徐平. CDK4/6信号通路靶向治疗剂在癌症治疗中的研究进展[J]. 生物工程学报, 2021, 37(7): 2232-2239.
[69] Michaloglou, C., Crafter, C., Siersbaek, R., Delpuech, O., Curwen, J.O., Carnevalli, L.S., et al. (2018) Combined Inhibition of mTOR and CDK4/6 Is Required for Optimal Blockade of E2F Function and Long-Term Growth Inhibition in Estrogen Receptor-Positive Breast Cancer. Molecular Cancer Therapeutics, 17, 908-920. [Google Scholar] [CrossRef] [PubMed]
[70] Rugo, H.S., Lerebours, F., Ciruelos, E., Drullinsky, P., Ruiz-Borrego, M., Neven, P., et al. (2021) Alpelisib Plus Fulvestrant in PIK3CA-Mutated, Hormone Receptor-Positive Advanced Breast Cancer after a CDK4/6 Inhibitor (BYLieve): One Cohort of a Phase 2, Multicentre, Open-Label, Non-Comparative Study. The Lancet Oncology, 22, 489-498. [Google Scholar] [CrossRef] [PubMed]
[71] Soare, G.R. and Soare, C.A. (2019) Immunotherapy for Breast Cancer: First FDA Approved Regimen. Discoveries, 7, e91. [Google Scholar] [CrossRef] [PubMed]