PI3K‐AKT‐mTOR inhibitors in breast cancers: From tumor cell signaling to clinical trials

&NA; Breast cancer (BC) is the most common women cancer and second most common cause of cancer death in women. A woman living in the United States has 12.3% lifetime risk of being diagnosed with BC. From the genomics point of view, the most common three subtypes of BC encountered in clinics are HR +, HER2 +, and TNBC or basal‐like BC. Estrogen receptor (ER) status or HER2 amplification or chemotherapy is not sufficient to understand the underlying mechanisms of disease progression and resistance (de novo or acquire). Although hormonal therapy and HER2‐directed therapies have produced a considerable positive outcome in HR + and HER2 + BC respectively, there are no established targeted agents for TNBC and basal‐like BC. While PARP inhibitors have shown promising activity in BRCA‐related cancers, its value in the treatment of TNBC remains to be demonstrated. The PI3K‐AKT‐mTOR signaling pathway plays a crucial role in the initiation and progress in tumorigenesis including breast tumorigenesis and regulates critical cellular functions including survival, proliferation, and metabolism. This article aims to understand the role of PI3K‐mTORC1/C2 alterations in determining the clinical outcome in the specific breast cancer subtypes. The understanding of the tumor cell signaling will help us in the decision‐making the process for obtaining the treatment modalities towards further advancement of the precision medicine. In this review, we will restrict our discussion to a basic understanding of the biology of subtype‐specific BC and several targeted agents under development for the treatment of BC.

[1]  L. Cantley,et al.  Oncogenes and signal transduction , 1991, Cell.

[2]  J. Uhm Clonal selection drives genetic divergence of metastatic medulloblastoma , 2012 .

[3]  J. Balko,et al.  Triple-negative breast cancer: challenges and opportunities of a heterogeneous disease , 2016, Nature Reviews Clinical Oncology.

[4]  J. Baselga,et al.  Pharmacology in the Era of Targeted Therapies: The Case of PI3K Inhibitors , 2016, Clinical Cancer Research.

[5]  Philippe Dessen,et al.  Molecular Characterization of Breast Cancer with High-Resolution Oligonucleotide Comparative Genomic Hybridization Array , 2009, Clinical Cancer Research.

[6]  J. Engelman,et al.  The PI3K pathway as drug target in human cancer. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  W. Muller,et al.  HER3 is required for HER2-induced preneoplastic changes to the breast epithelium and tumor formation. , 2012, Cancer research.

[8]  C. Sotiriou,et al.  Beyond trastuzumab: new treatment options for HER2-positive breast cancer. , 2011, Breast.

[9]  K. Gelmon,et al.  Phase II trial of pertuzumab and trastuzumab in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer that progressed during prior trastuzumab therapy. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  B. Leyland-Jones,et al.  Whither HER2-related therapeutics? , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  J. Baselga,et al.  PIK3CA Status in Circulating Tumor DNA Predicts Efficacy of Buparlisib Plus Fulvestrant in Postmenopausal Women With Endocrine-resistant HR+/HER2- Advanced Breast Cancer: First Results From the Randomized, Phase III BELLE-2 Trial , 2015 .

[12]  M. Piccart,et al.  Everolimus Plus Exemestane in Postmenopausal Patients with HR+ Breast Cancer: BOLERO-2 Final Progression-Free Survival Analysis , 2013, Advances in Therapy.

[13]  J. Vaqué,et al.  Interaction between FGFR-2, STAT5, and progesterone receptors in breast cancer. , 2011, Cancer research.

[14]  G. Mills,et al.  LKB1 is a central regulator of tumor initiation and pro-growth metabolism in ErbB2-mediated breast cancer , 2013, Cancer & Metabolism.

[15]  C. Isaacs,et al.  Molecular Alterations and Everolimus Efficacy in Human Epidermal Growth Factor Receptor 2-Overexpressing Metastatic Breast Cancers: Combined Exploratory Biomarker Analysis From BOLERO-1 and BOLERO-3. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  W. McGuire,et al.  Human breast cancer: correlation of relapse and survival with amplification of the HER-2/neu oncogene. , 1987, Science.

[17]  A. González-Angulo,et al.  Targeting the phosphatidylinositol 3-kinase signaling pathway in breast cancer. , 2011, The oncologist.

[18]  T. Fleming,et al.  Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. , 2001, The New England journal of medicine.

[19]  P. Libby,et al.  PDGF-dependent tyrosine phosphorylation stimulates production of novel polyphosphoinositides in intact cells , 1989, Cell.

[20]  M. Ellis,et al.  Pictilisib for oestrogen receptor-positive, aromatase inhibitor-resistant, advanced or metastatic breast cancer (FERGI): a randomised, double-blind, placebo-controlled, phase 2 trial. , 2016, The Lancet. Oncology.

[21]  S. Staal Molecular cloning of the akt oncogene and its human homologues AKT1 and AKT2: amplification of AKT1 in a primary human gastric adenocarcinoma. , 1987, Proceedings of the National Academy of Sciences of the United States of America.

[22]  G. Hortobagyi,et al.  Chemotherapy and targeted therapy for women with human epidermal growth factor receptor 2-negative (or unknown) advanced breast cancer: American Society of Clinical Oncology Clinical Practice Guideline. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[23]  Violeta Serra,et al.  Phosphatidylinositol 3-kinase hyperactivation results in lapatinib resistance that is reversed by the mTOR/phosphatidylinositol 3-kinase inhibitor NVP-BEZ235. , 2008, Cancer research.

[24]  D. Generali,et al.  A Phase Ib Open-Label Study to Assess the Safety and Tolerability of Everolimus in Combination With Eribulin in Triple-Negative Breast Cancers. , 2016, Clinical breast cancer.

[25]  I. Ray-Coquard,et al.  Randomized phase II trial of everolimus in combination with tamoxifen in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer with prior exposure to aromatase inhibitors: a GINECO study. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[26]  C. Anders,et al.  The Evolution of Triple-Negative Breast Cancer: From Biology to Novel Therapeutics. , 2016, American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting.

[27]  Hailing Cheng,et al.  The p110α and p110β isoforms of PI3K play divergent roles in mammary gland development and tumorigenesis. , 2012, Genes & development.

[28]  A. Tutt,et al.  3rd ESO-ESMO international consensus guidelines for Advanced Breast Cancer (ABC 3). , 2017, Breast.

[29]  P. De,et al.  A critical role for HER3 in HER2-amplified and non-amplified breast cancers: function of a kinase-dead RTK. , 2015, American journal of translational research.

[30]  M. Gnant,et al.  Co-overexpression of HER2/HER3 is a predictor of impaired survival in breast cancer patients. , 2014, Breast.

[31]  B. Leyland-Jones,et al.  Promise of rapalogues versus mTOR kinase inhibitors in subset specific breast cancer: old targets new hope. , 2013, Cancer treatment reviews.

[32]  A. Zelenetz,et al.  Idelalisib and rituximab in relapsed chronic lymphocytic leukemia. , 2014, The New England journal of medicine.

[33]  E. Winer,et al.  PI3K-p110α mediates resistance to HER2-targeted therapy in HER2+, PTEN-deficient breast cancers , 2016, Oncogene.

[34]  J. Thigpen Everolimus in Postmenopausal Hormone-Receptor–Positive Advanced Breast Cancer , 2012 .

[35]  Qingyuan Zhang,et al.  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. , 2015, The Lancet. Oncology.

[36]  Igor Goryanin,et al.  Systems biology reveals new strategies for personalizing cancer medicine and confirms the role of PTEN in resistance to trastuzumab. , 2009, Cancer research.

[37]  A. Citri,et al.  EGF–ERBB signalling: towards the systems level , 2006, Nature Reviews Molecular Cell Biology.

[38]  Su-In Lee,et al.  The proteomic landscape of triple-negative breast cancer. , 2015, Cell reports.

[39]  H. Lane,et al.  The mTOR Inhibitor RAD 001 Sensitizes Tumor Cells to DNA-Damaged Induced Apoptosis through Inhibition of p 21 Translation , 2005 .

[40]  J. Baselga,et al.  MONARCH1: Results from a phase II study of abemaciclib, a CDK4 and CDK6 inhibitor, as monotherapy, in patients with HR+/HER2- breast cancer, after chemotherapy for advanced disease. , 2016 .

[41]  C. Perou,et al.  Molecular Features and Survival Outcomes of the Intrinsic Subtypes Within HER2-Positive Breast Cancer , 2014, Journal of the National Cancer Institute.

[42]  H. Lane,et al.  Specific apoptosis induction by the dual PI3K/mTor inhibitor NVP-BEZ235 in HER2 amplified and PIK3CA mutant breast cancer cells , 2009, Proceedings of the National Academy of Sciences.

[43]  G. Mills,et al.  Open label, randomized clinical trial of standard neoadjuvant chemotherapy with paclitaxel followed by FEC (T-FEC) versus the combination of paclitaxel and RAD001 followed by FEC (TR-FEC) in women with triple receptor-negative breast cancer (TNBC). , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[44]  K. Blackwell,et al.  Understanding the mechanisms behind trastuzumab therapy for human epidermal growth factor receptor 2-positive breast cancer. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[45]  V. Karantza,et al.  Abstract S5-07: Preliminary efficacy and safety of pembrolizumab (MK-3475) in patients with PD-L1–positive, estrogen receptor-positive (ER+)/HER2-negative advanced breast cancer enrolled in KEYNOTE-028 , 2016 .

[46]  P. Neven,et al.  Everolimus plus exemestane for hormone-receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer: overall survival results from BOLERO-2†. , 2014, Annals of oncology : official journal of the European Society for Medical Oncology.

[47]  Giulia Bianchi,et al.  Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. , 2012, The Lancet. Oncology.

[48]  G. Hortobagyi,et al.  Correlation of molecular alterations with efficacy of everolimus in hormone-receptor-positive, HER2-negative advanced breast cancer: Results from BOLERO-2. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[49]  Steven J. M. Jones,et al.  Comprehensive molecular portraits of human breast tumors , 2012, Nature.

[50]  D. Guertin,et al.  Phosphorylation and Regulation of Akt/PKB by the Rictor-mTOR Complex , 2005, Science.

[51]  T. Pawson ReviewSpecificity in Signal Transduction : From Phosphotyrosine-SH 2 Domain Interactions to Complex Cellular Systems , 2004 .

[52]  Franziska Michor,et al.  In situ single cell analysis identifies heterogeneity for PIK3CA mutation and HER2 amplification in HER2+ breast cancer , 2015, Nature Genetics.

[53]  J. Baselga,et al.  Benefit to neoadjuvant anti-human epidermal growth factor receptor 2 (HER2)-targeted therapies in HER2-positive primary breast cancer is independent of phosphatase and tensin homolog deleted from chromosome 10 (PTEN) status. , 2015, Annals of oncology : official journal of the European Society for Medical Oncology.

[54]  P. Pandolfi,et al.  Combining a PI3K inhibitor with a PARP inhibitor provides an effective therapy for BRCA1-related breast cancer. , 2012, Cancer discovery.

[55]  C. Sawyers,et al.  The phosphatidylinositol 3-Kinase–AKT pathway in human cancer , 2002, Nature Reviews Cancer.

[56]  C. Perou,et al.  Mutant PIK3CA accelerates HER2-driven transgenic mammary tumors and induces resistance to combinations of anti-HER2 therapies , 2013, Proceedings of the National Academy of Sciences.

[57]  J. Bergh,et al.  Clinically used breast cancer markers such as estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 are unstable throughout tumor progression. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[58]  C. Sotiriou,et al.  Somatic Mutation Profiling and Associations With Prognosis and Trastuzumab Benefit in Early Breast Cancer , 2013, Journal of the National Cancer Institute.

[59]  E. Winer,et al.  Poly(ADP-Ribose) Polymerase Inhibition: “Targeted” Therapy for Triple-Negative Breast Cancer , 2010, Clinical Cancer Research.

[60]  C. Perou,et al.  The genomic landscape of breast cancer as a therapeutic roadmap. , 2013, Cancer discovery.

[61]  Michael Gnant,et al.  Capecitabine and trastuzumab in heavily pretreated metastatic breast cancer. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[62]  M. Ellis,et al.  Abstract S2-02: The FERGI phase II study of the PI3K inhibitor pictilisib (GDC-0941) plus fulvestrant vs fulvestrant plus placebo in patients with ER+, aromatase inhibitor (AI)-resistant advanced or metastatic breast cancer – Part I results , 2015 .

[63]  M. Berger,et al.  Lapatinib plus capecitabine for HER2-positive advanced breast cancer. , 2006, The New England journal of medicine.

[64]  S. Paik,et al.  Intrinsic subtypes, PIK3CA mutation, and the degree of benefit from adjuvant trastuzumab in the NSABP B-31 trial. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[65]  N. Spector,et al.  Pertuzumab Protects the Achilles' Heel of Trastuzumab—Emtansine , 2013, Clinical Cancer Research.

[66]  Sohrab P. Shah,et al.  Dynamics of genomic clones in breast cancer patient xenografts at single-cell resolution , 2014, Nature.

[67]  Anne M Wallace,et al.  Adaptive Randomization of Veliparib-Carboplatin Treatment in Breast Cancer. , 2016, The New England journal of medicine.

[68]  A. Ashworth,et al.  Loss of 16q in high grade breast cancer is associated with estrogen receptor status: Evidence for progression in tumors with a luminal phenotype? , 2009, Genes, chromosomes & cancer.

[69]  M. Holz,et al.  S6 Kinase 1 Regulates Estrogen Receptor α in Control of Breast Cancer Cell Proliferation* , 2009, Journal of Biological Chemistry.

[70]  D. Booser,et al.  Inhibition of the phosphoinositide 3-kinase pathway for the treatment of patients with metastatic metaplastic breast cancer. , 2015, Annals of oncology : official journal of the European Society for Medical Oncology.

[71]  J. Bartlett,et al.  AKT activation predicts outcome in breast cancer patients treated with tamoxifen , 2005, The Journal of pathology.

[72]  E. Winer,et al.  Phase III study of iniparib plus gemcitabine and carboplatin versus gemcitabine and carboplatin in patients with metastatic triple-negative breast cancer. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[73]  J. Cambier,et al.  Activation of phosphatidylinositol-3' kinase by Src-family kinase SH3 binding to the p85 subunit. , 1994, Science.

[74]  V. Brouste,et al.  Comprehensive analysis of PTEN status in breast carcinomas , 2013, International journal of cancer.

[75]  B. Leyland-Jones,et al.  Molecular determinants of trastuzumab efficacy: What is their clinical relevance? , 2013, Cancer treatment reviews.

[76]  J. Baselga,et al.  Biomarker analyses in CLEOPATRA: a phase III, placebo-controlled study of pertuzumab in human epidermal growth factor receptor 2-positive, first-line metastatic breast cancer. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[77]  L. Saal,et al.  Integrated molecular pathway analysis informs a synergistic combination therapy targeting PTEN/PI3K and EGFR pathways for basal-like breast cancer , 2016, BMC Cancer.

[78]  H. Lane,et al.  The mTOR Inhibitor RAD001 Sensitizes Tumor Cells to DNA-Damaged Induced Apoptosis through Inhibition of p21 Translation , 2005, Cell.

[79]  F. Montemurro,et al.  Outcome of patients with HER2-positive advanced breast cancer progressing during trastuzumab-based therapy. , 2006, The oncologist.

[80]  I. Lax,et al.  Stimulation of phosphatidylinositol 3-kinase by fibroblast growth factor receptors is mediated by coordinated recruitment of multiple docking proteins , 2001, Proceedings of the National Academy of Sciences of the United States of America.

[81]  A. Tutt,et al.  Triple negative tumours: a critical review , 2007, Histopathology.

[82]  Y. Im,et al.  S5-1: Neoadjuvant Pertuzumab (P) and Trastuzumab (H): Biomarker Analyses of a 4-Arm Randomized Phase II Study (NeoSphere) in Patients (pts) with HER2−Positive Breast Cancer (BC). , 2011 .

[83]  S. Adams,et al.  Abstract P2-11-06: Safety and clinical activity of atezolizumab (anti-PDL1) in combination with nab-paclitaxel in patients with metastatic triple-negative breast cancer , 2016 .

[84]  R. Rosli,et al.  Rapamycin synergizes cisplatin sensitivity in basal-like breast cancer cells through up-regulation of p73 , 2011, Breast Cancer Research and Treatment.

[85]  A. Psyrri,et al.  p85 Protein Expression is Associated with Poor Survival in HER2-Positive Patients with Advanced Breast Cancer Treated with Trastuzumab , 2015, Pathology & Oncology Research.

[86]  S. Chandarlapaty,et al.  Predictive Biomarkers and Personalized Medicine Frequent Mutational Activation of the PI 3 K-AKT Pathway in Trastuzumab-Resistant Breast Cancer , 2012 .

[87]  Nahum Sonenberg,et al.  Dissecting the role of mTOR: lessons from mTOR inhibitors. , 2010, Biochimica et biophysica acta.

[88]  Monilola A. Olayioye,et al.  The ErbB signaling network: receptor heterodimerization in development and cancer , 2000, The EMBO journal.

[89]  F. Marmé,et al.  Immunotherapy in Breast Cancer , 2016, Oncology Research and Treatment.

[90]  D. Yee,et al.  Crosstalk Between IGF1R and Estrogen Receptor Signaling in Breast Cancer , 2008, Journal of Mammary Gland Biology and Neoplasia.

[91]  M. Piccart,et al.  ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2)† , 2014, Annals of oncology : official journal of the European Society for Medical Oncology.

[92]  L. Skoog,et al.  PIK3CA Mutations and PTEN Loss Correlate with Similar Prognostic Factors and Are Not Mutually Exclusive in Breast Cancer , 2007, Clinical Cancer Research.

[93]  B. Smith,et al.  Targeting basal-like breast cancers. , 2012, Current drug targets.

[94]  C. Isaacs,et al.  Everolimus for women with trastuzumab-resistant, HER2-positive, advanced breast cancer (BOLERO-3): a randomised, double-blind, placebo-controlled phase 3 trial. , 2014, The Lancet. Oncology.

[95]  J. Palazzo,et al.  Comprehensive profiling of metaplastic breast carcinomas reveals frequent overexpression of programmed death-ligand 1 , 2016, Journal of Clinical Pathology.

[96]  Emmanuel Barillot,et al.  Frequent PTEN genomic alterations and activated phosphatidylinositol 3-kinase pathway in basal-like breast cancer cells , 2008, Breast Cancer Research.

[97]  J. Baselga,et al.  NVP-BEZ235, a dual PI3K/mTOR inhibitor, prevents PI3K signaling and inhibits the growth of cancer cells with activating PI3K mutations. , 2008, Cancer research.

[98]  Matthew J. Ellis,et al.  Molecular Basis of Triple Negative Breast Cancer and Implications for Therapy , 2011, International journal of breast cancer.

[99]  X. Chen,et al.  Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. , 2011, The Journal of clinical investigation.

[100]  M. Rezai,et al.  Neoadjuvant chemotherapy with paclitaxel and everolimus in breast cancer patients with non-responsive tumours to epirubicin/cyclophosphamide (EC) ± bevacizumab - results of the randomised GeparQuinto study (GBG 44). , 2013, European journal of cancer.

[101]  Z. Szallasi,et al.  Homologous Recombination Deficiency (HRD) Score Predicts Response to Platinum-Containing Neoadjuvant Chemotherapy in Patients with Triple-Negative Breast Cancer , 2016, Clinical Cancer Research.

[102]  B. Leyland-Jones,et al.  PI3K-mTOR in Cancer and Cancer Therapy , 2016 .

[103]  S. R. Datta,et al.  Cellular survival: a play in three Akts. , 1999, Genes & development.

[104]  D. Sabatini,et al.  mTOR: from growth signal integration to cancer, diabetes and ageing , 2010, Nature Reviews Molecular Cell Biology.

[105]  Nicholas T. Ingolia,et al.  The translational landscape of mTOR signalling steers cancer initiation and metastasis , 2012, Nature.

[106]  L. Cantley,et al.  Phosphoinositide 3-kinase inhibitors induce DNA damage through nucleoside depletion , 2016, Proceedings of the National Academy of Sciences.

[107]  L. Cantley,et al.  Association of phosphatidylinositol kinase activity with polyoma middle-T competent for transformation , 1985, Nature.

[108]  M. Sliwkowski,et al.  Ligand-independent HER2/HER3/PI3K complex is disrupted by trastuzumab and is effectively inhibited by the PI3K inhibitor GDC-0941. , 2009, Cancer cell.

[109]  N. Biglia,et al.  Metformin use and gynecological cancers: A novel treatment option emerging from drug repositioning. , 2016, Critical reviews in oncology/hematology.

[110]  Lisa M Haley,et al.  Performance characteristics of next-generation sequencing in clinical mutation detection of colorectal cancers , 2015, Modern Pathology.

[111]  L. Aicher,et al.  Activated mammalian target of rapamycin pathway in the pathogenesis of tuberous sclerosis complex renal tumors. , 2002, Cancer research.

[112]  Ming Tan,et al.  PTEN activation contributes to tumor inhibition by trastuzumab, and loss of PTEN predicts trastuzumab resistance in patients. , 2004, Cancer cell.

[113]  E. Frenkel,et al.  Molecular heterogeneity in adjacent cells in triple-negative breast cancer , 2015, Breast cancer.

[114]  J. Baselga,et al.  Abstract S6-01:PIK3CAstatus in circulating tumor DNA (ctDNA) predicts efficacy of buparlisib (BUP) plus fulvestrant (FULV) in postmenopausal women with endocrine-resistant HR+/HER2– advanced breast cancer (BC): First results from the randomized, phase III BELLE-2 trial: , 2016 .

[115]  J. Ware,et al.  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 , 2014, Clinical Cancer Research.

[116]  M. Ellis,et al.  A Phase I Study of the AKT Inhibitor MK-2206 in Combination with Hormonal Therapy in Postmenopausal Women with Estrogen Receptor–Positive Metastatic Breast Cancer , 2016, Clinical Cancer Research.

[117]  J. Testa,et al.  Perturbations of the AKT signaling pathway in human cancer , 2005, Oncogene.

[118]  G. Mills,et al.  Open-label randomized clinical trial of standard neoadjuvant chemotherapy with paclitaxel followed by FEC versus the combination of paclitaxel and everolimus followed by FEC in women with triple receptor-negative breast cancer†. , 2014, Annals of oncology : official journal of the European Society for Medical Oncology.

[119]  Lei He,et al.  PI3K inhibition impairs BRCA1/2 expression and sensitizes BRCA-proficient triple-negative breast cancer to PARP inhibition. , 2012, Cancer discovery.

[120]  J. Baselga,et al.  Randomized study of Lapatinib alone or in combination with trastuzumab in women with ErbB2-positive, trastuzumab-refractory metastatic breast cancer. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[121]  D. Stern ERBB3/HER3 and ERBB2/HER2 Duet in Mammary Development and Breast Cancer , 2008, Journal of Mammary Gland Biology and Neoplasia.

[122]  Carlos Caldas,et al.  The implications of clonal genome evolution for cancer medicine. , 2013, The New England journal of medicine.

[123]  G. Mills,et al.  mTOR Inhibitors Suppress Homologous Recombination Repair and Synergize with PARP Inhibitors via Regulating SUV39H1 in BRCA-Proficient Triple-Negative Breast Cancer , 2015, Clinical Cancer Research.

[124]  J. Tamburini,et al.  LKB1/AMPK/mTOR signaling pathway in hematological malignancies: From metabolism to cancer cell biology , 2011, Cell cycle.

[125]  O. Delpuech,et al.  Intermittent High-Dose Scheduling of AZD8835, a Novel Selective Inhibitor of PI3Kα and PI3Kδ, Demonstrates Treatment Strategies for PIK3CA-Dependent Breast Cancers , 2016, Molecular Cancer Therapeutics.

[126]  R. Laing,et al.  Pictilisib PI3Kinase inhibitor (a phosphatidylinositol 3-kinase [PI3K] inhibitor) plus paclitaxel for the treatment of hormone receptor-positive, HER2-negative, locally recurrent, or metastatic breast cancer: interim analysis of the multicentre, placebo-controlled, phase II randomised PEGGY study. , 2016, Annals of oncology : official journal of the European Society for Medical Oncology.

[127]  Alain Viari,et al.  A whole-genome sequence and transcriptome perspective on HER2-positive breast cancers , 2016, Nature Communications.

[128]  J. Thigpen Iniparib plus Chemotherapy in Metastatic Triple-Negative Breast Cancer , 2011 .

[129]  Andrew M. K. Brown,et al.  Variable Clonal Repopulation Dynamics Influence Chemotherapy Response in Colorectal Cancer , 2013, Science.

[130]  G. Ragsdell Systems , 2002, Economics of Visual Art.

[131]  D. Berry,et al.  Adaptively randomized trial of neoadjuvant chemotherapy with or without the Akt inhibitor MK-2206: Graduation results from the I-SPY 2 Trial. , 2015 .

[132]  R. Bernards,et al.  PIK3CA mutations are associated with reduced pathological complete response rates in primary HER2-positive breast cancer: pooled analysis of 967 patients from five prospective trials investigating lapatinib and trastuzumab. , 2019, Annals of oncology : official journal of the European Society for Medical Oncology.

[133]  J. Baselga,et al.  Dual human epidermal growth factor receptor 2 (HER2) blockade and hormonal therapy for the treatment of primary HER2-positive breast cancer: one more step toward chemotherapy-free therapy. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[134]  P. Fasching,et al.  Integrated Analysis of PTEN and p4EBP1 Protein Expression as Predictors for pCR in HER2-Positive Breast Cancer , 2016, Clinical Cancer Research.

[135]  G. Giles,et al.  Inositol polyphosphate 4-phosphatase II regulates PI3K/Akt signaling and is lost in human basal-like breast cancers , 2010, Proceedings of the National Academy of Sciences.

[136]  S. Chandarlapaty,et al.  Frequent Mutational Activation of the PI3K-AKT Pathway in Trastuzumab-Resistant Breast Cancer , 2012, Clinical Cancer Research.

[137]  M. Greenberg,et al.  Akt Promotes Cell Survival by Phosphorylating and Inhibiting a Forkhead Transcription Factor , 1999, Cell.

[138]  G. Hortobagyi,et al.  Correlation of molecular alterations with efficacy of everolimus in hormone receptor–positive, HER2-negative advanced breast cancer: Results from BOLERO-2. , 2013 .

[139]  S. Shoelson,et al.  Inhibition of SH2 domain/phosphoprotein association by a nonhydrolyzable phosphonopeptide. , 1992, Biochemistry.

[140]  L. Cantley,et al.  Type I phosphatidylinositol kinase makes a novel inositol phospholipid, phosphatidylinositol-3-phosphate , 1988, Nature.

[141]  G. Mills,et al.  Targeting Mammalian Target of Rapamycin Synergistically Enhances Chemotherapy-Induced Cytotoxicity in Breast Cancer Cells , 2004, Clinical Cancer Research.

[142]  B. Leyland-Jones,et al.  Anti-tumor efficacy of BEZ235 is complemented by its anti-angiogenic effects via downregulation of PI3K-mTOR-HIF1alpha signaling in HER2-defined breast cancers. , 2016, American journal of cancer research.

[143]  J. Downward,et al.  Role of RAS in the regulation of PI 3-kinase. , 2010, Current topics in microbiology and immunology.

[144]  J. Mackey,et al.  PTEN Loss Is Associated with Worse Outcome in HER2-Amplified Breast Cancer Patients but Is Not Associated with Trastuzumab Resistance , 2015, Clinical Cancer Research.

[145]  Brian H. Dunford-Shore,et al.  Somatic mutations affect key pathways in lung adenocarcinoma , 2008, Nature.

[146]  T. Pawson,et al.  Assembly of Cell Regulatory Systems Through Protein Interaction Domains , 2003, Science.

[147]  G. Jerusalem,et al.  Triple-negative breast cancer: treatment challenges and solutions , 2016, Breast cancer.

[148]  Steven J. M. Jones,et al.  Comprehensive molecular portraits of human breast tumours , 2013 .

[149]  Andrew Menzies,et al.  Subclonal diversification of primary breast cancer revealed by multiregion sequencing , 2015, Nature Medicine.

[150]  F. Markowetz,et al.  The genomic and transcriptomic architecture of 2,000 breast tumours reveals novel subgroups , 2012, Nature.

[151]  M. V. Estrada,et al.  Rictor/mTORC2 Drives Progression and Therapeutic Resistance of HER2-Amplified Breast Cancers. , 2016, Cancer Research.

[152]  L. Pusztai,et al.  New Strategies in Breast Cancer: Immunotherapy , 2016, Clinical Cancer Research.

[153]  G. Botti,et al.  Heterogeneity of KRAS, NRAS, BRAF and PIK3CA mutations in metastatic colorectal cancer and potential effects on therapy in the CAPRI GOIM trial. , 2015, Annals of oncology : official journal of the European Society for Medical Oncology.

[154]  Z. Szallasi,et al.  Homologous Recombination De fi ciency ( HRD ) Score Predicts Response to Platinum-Containing Neoadjuvant Chemotherapy in Patients with Triple-Negative Breast Cancer , 2016 .

[155]  J. Baselga,et al.  Trastuzumab emtansine for HER2-positive advanced breast cancer. , 2012, The New England journal of medicine.

[156]  L. Chow,et al.  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. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[157]  F. Maurer,et al.  The ErbB2/ErbB3 heterodimer functions as an oncogenic unit: ErbB2 requires ErbB3 to drive breast tumor cell proliferation , 2003, Proceedings of the National Academy of Sciences of the United States of America.

[158]  A. Eastman,et al.  Strategically Timing Inhibition of Phosphatidylinositol 3-Kinase to Maximize Therapeutic Index in Estrogen Receptor Alpha–Positive, PIK3CA-Mutant Breast Cancer , 2016, Clinical Cancer Research.

[159]  P. Sharma,et al.  Biology and Management of Patients With Triple-Negative Breast Cancer. , 2016, The oncologist.

[160]  G. Hortobagyi,et al.  Prevalence of ESR1 Mutations in Cell-Free DNA and Outcomes in Metastatic Breast Cancer: A Secondary Analysis of the BOLERO-2 Clinical Trial. , 2016, JAMA oncology.

[161]  J. Ahn,et al.  Role of HER3 expression and PTEN loss in patients with HER2-overexpressing metastatic breast cancer (MBC) who received taxane plus trastuzumab treatment , 2013, British Journal of Cancer.

[162]  M. Odenthal,et al.  Targeted next generation sequencing of parotid gland cancer uncovers genetic heterogeneity , 2015, Oncotarget.

[163]  E. Winer,et al.  A Phase Ib Study of Alpelisib (BYL719), a PI3Kα-Specific Inhibitor, with Letrozole in ER+/HER2− Metastatic Breast Cancer , 2016, Clinical Cancer Research.

[164]  Jordi Rodon,et al.  Phase I Safety, Pharmacokinetic, and Pharmacodynamic Study of SAR245408 (XL147), an Oral Pan-Class I PI3K Inhibitor, in Patients with Advanced Solid Tumors , 2013, Clinical Cancer Research.

[165]  L. Carey,et al.  Triple-negative breast cancer: disease entity or title of convenience? , 2010, Nature Reviews Clinical Oncology.

[166]  Y. C. Heng,et al.  Everolimus plus exemestane as first-line therapy in HR+, HER2− advanced breast cancer in BOLERO-2 , 2013, Breast Cancer Research and Treatment.

[167]  R. DePinho,et al.  The LKB1 tumor suppressor negatively regulates mTOR signaling. , 2004, Cancer cell.

[168]  Tony Pawson,et al.  Specificity in Signal Transduction From Phosphotyrosine-SH2 Domain Interactions to Complex Cellular Systems , 2004, Cell.