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Inhibitors of the PI3K/AKT/mTOR pathway in human malignancies; trend of current clinical trials

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Abstract

The phosphoinositide 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) signaling pathway regulates proliferation, survival and metabolism, and its dysregulation is one of the most frequent oncogenic events across human malignancies. Over the last two decades, there has been significant focus on the clinical development of PI3K pathway inhibitors. More than 40 different inhibitors of this axis have reached various stages of clinical trials, but only a few of them have been approved by the Food and Drug Administration (FDA) for cancer treatment. These clinical results, however, could be improved given the importance of PI3K signaling in cancer and its role in linking cancer growth with metabolism. In this systematic review, after a glance at PI3K/AKT/mTOR pathway and its different inhibitors, we retrieved registered clinical trials evaluating the efficacy and safety of PI3K/AKT/mTOR inhibitors on Clinicaltrials.gov. Following the extraction of the data, finally we analyzed 2250 included studies in multiple steps, beginning with an overview and moving on to the details about type of malignancies, inhibitors, and treatment strategies. We also took a closer look at more than 100 phase III-IV clinical trials to pinpoint promising therapies, ho** that presenting a comprehensive picture of current clinical trials casts a flash of light on what remains to be done in future clinical trials of PI3K/AKT/mTOR inhibitors in human malignancies.

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References

  • Akbari Dilmaghani N et al (2021) The PI3K/Akt/mTORC signaling axis in head and neck squamous cell carcinoma: Possibilities for therapeutic interventions either as single agents or in combination with conventional therapies. IUBMB Life 73(4):618–642

    Article  CAS  PubMed  Google Scholar 

  • Arcaro A, Wymann MP (1993) Wortmannin is a potent phosphatidylinositol 3-kinase inhibitor: the role of phosphatidylinositol 3, 4, 5-trisphosphate in neutrophil responses. Biochem J 296(2):297–301

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Castel P et al (2021) The present and future of PI3K inhibitors for cancer therapy. Nature Cancer 2(6):587–597

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chen J et al (2018) miR-21-5p confers doxorubicin resistance in gastric cancer cells by targeting PTEN and TIMP3. Int J Mol Med 41(4):1855–1866

    CAS  PubMed  PubMed Central  Google Scholar 

  • Ciraolo E, Morello F, Hirsch E (2011) Present and future of PI3K pathway inhibition in cancer: perspectives and limitations. Curr Med Chem 18(18):2674–2685

    Article  CAS  PubMed  Google Scholar 

  • Clayton E et al (2002) A crucial role for the p110δ subunit of phosphatidylinositol 3-kinase in B cell development and activation. J Exp Med 196(6):753–763

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • De Vera AA, Reznik SE (2019) Combining PI3K/Akt/mTOR inhibition with chemotherapy. Protein kinase inhibitors as sensitizing agents for chemotherapy. Elsevier, pp 229–242

    Chapter  Google Scholar 

  • Dharmamoorthy G et al (2022) A review on FDA approval of lymphoma drug ukoniq (Umbralisib) And Its withdrwal due to safety concerns. J Pharm Negat Results 13(4):1465–1474

    CAS  Google Scholar 

  • Dienstmann R et al (2014) Picking the point of inhibition: a comparative review of PI3K/AKT/mTOR pathway inhibitorsdifferentiating PI3K/AKT/mTOR pathway inhibitors. Mol Cancer Ther 13(5):1021–1031

    Article  CAS  PubMed  Google Scholar 

  • FDA withdrew its approval for the cancer medicine Ukoniq (umbralisib) due to safety concerns. 2022; Available from: https://bit.ly/3FC651c.

  • Hassan B et al (2013) Targeting the PI3-kinase/Akt/mTOR signaling pathway. Surg Oncol Clin 22(4):641–664

    Article  Google Scholar 

  • He Y et al (2021) Targeting PI3K/Akt signal transduction for cancer therapy. Signal Transduct Target Ther 6(1):425

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hillmann P, Fabbro D (2019) PI3K/mTOR pathway inhibition: opportunities in oncology and rare genetic diseases. Int J Mol Sci 20(22):5792

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hoxhaj G, Manning BD (2020) The PI3K–AKT network at the interface of oncogenic signalling and cancer metabolism. Nat Rev Cancer 20(2):74–88

    Article  CAS  PubMed  Google Scholar 

  • Janku F (2017) Phosphoinositide 3-kinase (PI3K) pathway inhibitors in solid tumors: from laboratory to patients. Cancer Treat Rev 59:93–101

    Article  CAS  PubMed  Google Scholar 

  • Janku F, Yap TA, Meric-Bernstam F (2018) Targeting the PI3K pathway in cancer: are we making headway? Nat Rev Clin Oncol 15(5):273–291

    Article  CAS  PubMed  Google Scholar 

  • Khorasani ABS et al (2021) The PI3K/Akt/mTOR signaling pathway in gastric cancer; from oncogenic variations to the possibilities for pharmacologic interventions. Eur J Pharmacol 898:173983

    Article  Google Scholar 

  • Khwaja A (2011) PI3K as a target for therapy in haematological malignancies. Phosphoinositide 3-kinase in health and disease, vol 2. Springer, Berlin, pp 169–188

    Google Scholar 

  • Kumar CC, Madison V (2005) AKT crystal structure and AKT-specific inhibitors. Oncogene 24(50):7493–7501

    Article  CAS  PubMed  Google Scholar 

  • Massacesi C et al (2013) Challenges in the clinical development of PI3K inhibitors. Ann N Y Acad Sci 1280(1):19–23

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Motzer RJ et al (2008) Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. The Lancet 372(9637):449–456

    Article  CAS  Google Scholar 

  • Nicholson KM, Anderson NG (2002) The protein kinase B/Akt signalling pathway in human malignancy. Cell Signal 14(5):381–395

    Article  CAS  PubMed  Google Scholar 

  • Obenauer JC, Cantley LC, Yaffe MB (2003) Scansite 2.0: proteome-wide prediction of cell signaling interactions using short sequence motifs. Nucleic Acids Res 31(13):3635–3641

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Oncologic drugs advisory committee meeting April 21, 2022. 2022; Available from: https://bit.ly/3Sfivyo.

  • Popova NV, Jücker M (2021) The role of mTOR signaling as a therapeutic target in cancer. Int J Mol Sci 22(4):1743

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Romashkova JA, Makarov SS (1999) NF-κB is a target of AKT in anti-apoptotic PDGF signalling. Nature 401(6748):86–90

    Article  CAS  PubMed  Google Scholar 

  • Roskoski R Jr (2021) Properties of FDA-approved small molecule phosphatidylinositol 3-kinase inhibitors prescribed for the treatment of malignancies. Pharmacol Res 168:105579

    Article  CAS  PubMed  Google Scholar 

  • Sanaei MJ et al (2022a) The PI3K/Akt/mTOR axis in colorectal cancer: oncogenic alterations, non-coding RNAs, therapeutic opportunities, and the emerging role of nanoparticles. J Cell Physiol 237(3):1720–1752

    Article  CAS  PubMed  Google Scholar 

  • Sanaei M-J et al (2022b) The PI3K/Akt/mTOR pathway in lung cancer; oncogenic alterations, therapeutic opportunities, challenges, and a glance at the application of nanoparticles. Transl Oncol 18:101364

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Shouse G, Danilova OV, Danilov AV (2022) Current status of phosphoinotiside-3 kinase inhibitors in blood cancers. Curr Opin Oncol 34(5):540–545

    Article  CAS  PubMed  Google Scholar 

  • Singh SS et al (2015) Targeting the PI3K/Akt signaling pathway in gastric carcinoma: a reality for personalized medicine? World J Gastroenterol 21(43):12261

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sirico M et al (2023) Current state and future challenges for PI3K inhibitors in cancer therapy. Cancers 15(3):703

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Vasan N, Cantley LC (2022) At a crossroads: how to translate the roles of PI3K in oncogenic and metabolic signalling into improvements in cancer therapy. Nat Rev Clin Oncol 19(7):471–485

    Article  CAS  PubMed  Google Scholar 

  • Vlahos CJ et al (1994) A specific inhibitor of phosphatidylinositol 3-kinase, 2-(4-morpholinyl)-8-phenyl-4H-1-benzopyran-4-one (LY294002). J Biol Chem 269(7):5241–5248

    Article  CAS  PubMed  Google Scholar 

  • Wang L, Harris TE, Lawrence JC (2008) Regulation of proline-rich Akt substrate of 40 kDa (PRAS40) function by mammalian target of rapamycin complex 1 (mTORC1)-mediated phosphorylation. J Biol Chem 283(23):15619–15627

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Weigelt B, Downward J (2012) Genomic determinants of PI3K pathway inhibitor response in cancer. Front Oncol 2:109

    Article  PubMed  PubMed Central  Google Scholar 

  • Xue C et al (2021) Crosstalk between circRNAs and the PI3K/AKT signaling pathway in cancer progression. Signal Transduct Target Ther 6(1):400

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Zinda MJ et al (2001) AKT-1,-2, and-3 are expressed in both normal and tumor tissues of the lung, breast, prostate, and colon. Clin Cancer Res 7(8):2475–2479

    CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to express their gratitude to Shahid Beheshti University of Medical Sciences (Tehran, Iran) for supporting this study.

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ZD-M: Investigation (lead), Data gathering (lead), Writing – Original Draft Preparation (lead), Writing – Review & Editing (supporting); FJ-R: Investigation (lead), Data gathering (lead), Writing – Original Draft Preparation (lead), Writing – Review & Editing (supporting); MD: Investigation (lead), Data gathering (lead); AP-S: Data gathering (supporting); Designing figures and graphs; DB: Conceptualization (lead), Supervision (lead), Writing – Review & Editing (lead), Project Administration.

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Correspondence to Davood Bashash.

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Davoodi-Moghaddam, Z., Jafari-Raddani, F., Delshad, M. et al. Inhibitors of the PI3K/AKT/mTOR pathway in human malignancies; trend of current clinical trials. J Cancer Res Clin Oncol 149, 15293–15310 (2023). https://doi.org/10.1007/s00432-023-05277-x

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