Development and safety of PI3K inhibitors in cancer

Arch Toxicol. 2023 Mar;97(3):635-650. doi: 10.1007/s00204-023-03440-4. Epub 2023 Feb 11.

Abstract

The phosphatidylinositol 3-kinase (PI3K) signalling pathway regulates cell survival, proliferation, migration, metabolism and other vital cellular life processes. In addition, activation of the PI3K signalling pathway is important for cancer development. As a result, a variety of PI3K inhibitors have been clinically developed to treat malignancies. Although several PI3K inhibitors have received approval from the Food and Drug Administration (FDA) for significant antitumour activity, frequent and severe adverse effects have greatly limited their clinical application. These toxicities are mostly on-target and immune-mediated; nevertheless, the underlying mechanisms are still unclear. Current management usually involves intervention through symptomatic treatment, with discontinuation if toxicity persists. Therefore, it is necessary to comprehensively understand these adverse events and ensure the clinical safety application of PI3K inhibitors by establishing the most effective management guidelines, appropriate intermittent dosing regimens and new combination administration. Here, the focus is on the development of PI3K inhibitors in cancer therapy, with particular emphasis on isoform-specific PI3K inhibitors. The most common adverse effects of PI3K inhibitors are also covered, as well as potential mechanisms and management approaches.

Keywords: Inhibitors; Management; Mechanism; PI3K; Toxicity.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents* / pharmacology
  • Drug-Related Side Effects and Adverse Reactions*
  • Humans
  • Neoplasms* / chemically induced
  • Phosphatidylinositol 3-Kinases / metabolism
  • Phosphoinositide-3 Kinase Inhibitors / therapeutic use
  • Phosphoinositide-3 Kinase Inhibitors / toxicity
  • Protein Kinase Inhibitors
  • Signal Transduction

Substances

  • Phosphatidylinositol 3-Kinases
  • Protein Kinase Inhibitors
  • Phosphoinositide-3 Kinase Inhibitors
  • Antineoplastic Agents