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Translational Therapeutics

The emerging role of PI3K inhibitors for solid tumour treatment and beyond

British Journal of Cancer volume 128, pages 2150–2162 (2023)Cite this article

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Abstract

Phosphoinositide 3-kinases (PI3Ks) play a central role in tumourigenesis with recurrent activating mutations of its p110α subunit (PIK3CA) identified in several tumours. Although several PI3K inhibitors are approved for haematological malignancies, only alpelisib was approved in solid tumours and for the treatment of PIK3CA-related overgrowth spectrum (PROS) syndrome. Traditional PI3K inhibitors inhibit both wild-type and mutant PI3K with almost equal potency, thus limiting their efficacy due to on-target toxicity. Since the initiation of phase I clinical trials investigating next generation allosteric mutant and isoform selective PIK3CA inhibitors, there has been a surge in interest in PIK3CA targeting in solid tumours. Preclinical characterisation of these compounds showed that maximal mutant protein inhibition fails to elicit metabolic and glucose homoeostasis dysregulation, one of the dose limiting toxicities of both selective and pan PI3K inhibitors. While extreme selectivity can be hypothesised to grant activity and safety advantage to these novel agents, on the other hand reduced benefit can be speculated for patients harbouring multiple or rare PIK3CA mutations. This review summarises the current understanding of PI3K alterations and the state-of-the-art treatment strategies in PI3K driven solid tumours, while also exploring the potential intrinsic and acquired resistance mechanisms to these agents, and the emerging role of mutant selective PIK3CA inhibitors.

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Fig. 1: (Top Panel) Inner pie-chart: frequency of PIK3CA gene alterations according to type (Missense mutations, Insertion/deletion mutations, Fusions, Amplifications, Mutations & amplifications and Miscellanea) in 10945 samples of the MSK-IMPACT Clinical Sequencing Cohort [3].
Fig. 2: A schematic representation of major class I PI3K signalling pathway.
Fig. 3: A schematic representation of most frequently observed PI3K resistance mechanisms.

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Authors and Affiliations

  1. Division of Early Drug Development for Innovative Therapy, European Institute of Oncology, IRCCS, 20141, Milan, Italy

    Carmen Belli, Matteo Repetto & Giuseppe Curigliano

  2. Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy

    Matteo Repetto & Giuseppe Curigliano

  3. Department of Informatics, System, and Communications (DISCo), University of Milano-Bicocca, Milan, Italy

    Santosh Anand

  4. Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70121, Bari, Italy

    Camillo Porta

  5. Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Vivek Subbiah

  6. Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Vivek Subbiah

  7. MD Anderson Cancer Network, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Vivek Subbiah

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CB conceptualised and supervised the study. All authors were involved in data curation, investigation, methodology, writing, reviewing, and editing. The final version was approved by all authors.

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Correspondence to Giuseppe Curigliano.

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MR reports travelling funding for Sanofi. CP remunerated Consultant and/or Speaker for: Angelini Pharma, AstraZeneca, BMS, Eisai, General Electric, Ipsen, MSD; Protocol Steering Committee Member for: BMS, Eisai and MSD. VS reports research grants from Eli Lilly/Loxo Oncology, Blueprint Medicines Corporation, Turning Point Therapeutics, Boston Pharmaceuticals, and Helsinn Pharmaceuticals, and a grant and an advisory board/consultant positions with Eli Lilly/Loxo Oncology during the conduct of the study, as well as research grants from Roche/Genentech, Bayer, GlaxoSmithKline, Nanocarrier, Vegenics, Celgene, Northwest Biotherapeutics, Berg Health, Incyte, Fujifilm, D3, Pfizer, Multivir, Amgen, AbbVie, Alfasigma, Agensys, Boston Biomedical, IderaPharma, Inhibrx, Exelixis, Blueprint Medicines, Altum, Dragonfly Therapeutics, Takeda, National Comprehensive Cancer Network, NCI-Cancer Therapy Evaluation Program, The University of Texas MD Anderson Cancer Center, Turning Point Therapeutics, Boston Pharmaceuticals, Novartis, PharmaMar, Medimmune, advisory board/consultant positions with Helsinn, Incyte, QED Pharma, Daiichi Sankyo, Signant Health, Novartis, Relay Therapeutics, Pfizer, Roche, and Medimmune, travel funds from PharmaMar, Incyte, ASCO, and ESMO, and other support from Medscape outside the submitted work. GC received honoraria for speaker’s engagement: Roche, Seattle Genetics, Novartis, Lilly, Pfizer, Foundation Medicine, NanoString, Samsung, Celltrion, BMS, MSD; honoraria for providing consultancy: Roche, Seattle Genetics, NanoString; honoraria for participating in Advisory Board: Roche, Lilly, Pfizer, Foundation Medicine, Samsung, Celltrion, Mylan; honoraria for writing engagement: Novartis, BMS; honoraria for participation in Ellipsis Scientific Affairs Group; Institutional research funding for conducting phase I and II clinical trials: Pfizer, Roche, Novartis, Sanofi, Celgene, Servier, Orion, AstraZeneca, Seattle Genetics, AbbVie, Tesaro, BMS, Merck Serono, Merck Sharp Dome, Janssen-Cilag, Philogen, Bayer, Medivation, Medimmune. All remaining authors have declared no conflict of interest.

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Belli, C., Repetto, M., Anand, S. et al. The emerging role of PI3K inhibitors for solid tumour treatment and beyond. Br J Cancer 128, 2150–2162 (2023). https://doi.org/10.1038/s41416-023-02221-1

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