Introduction: The Evolving Challenge of PI3K Inhibition
The phosphatidylinositol 3-kinase (PI3K) pathway is one of the most frequently dysregulated signaling cascades in human cancer. Specifically, mutations in the PIK3CA gene, which encodes the p110α catalytic subunit of PI3Kα, serve as potent oncogenic drivers in a wide array of solid tumors, most notably hormone receptor-positive (HR+) breast cancer. Despite the clear therapeutic potential of targeting this pathway, the clinical history of PI3K inhibitors has been marked by a precarious balance between efficacy and toxicity. Early-generation pan-PI3K inhibitors were often limited by off-target effects, while isoform-selective inhibitors, though more targeted, frequently encountered resistance or dose-limiting toxicities such as severe hyperglycemia, gastrointestinal distress, and skin rashes.