Role of mTOR in solid tumor systems: a therapeutical target against primary tumor growth, metastases, and angiogenesis

The mammalian target of rapamycin (mTOR) is a controller of cell growth with multiple effects on cancer development and progression. Being closely linked to key oncogenic pathways that regulate tumor cell growth and cell cycle progression, mTOR integrates the cellular response to mitogenic and growth stimuli. Rapamycin and its analogs temsirolimus and everolimus are specific inhibitors of mTOR that exert suppressive effects on proliferation, invasion, and metastasis and induce apoptosis of tumor cells. Apart from the direct effects of mTOR inhibitors on tumor cells, rapamycin and its analogs have potent antiangiogenic properties related to the suppression of vascular endothelial growth factor signal transduction. While the use of mTOR inhibitors as a monotherapy seems to be insufficient to effectively control tumor progression in most tumor entities, combination with tyrosine kinase inhibitors or cytotoxic agents might potentiate the antitumoral effects of mTOR inhibition. In a clinical setting, mTOR inhibitors show an acceptable safety profile over a wide dose range. Currently, mTOR inhibitors are tested in multiple trials in combination with other agents in various cancer entities in intermittent schedules to avoid immunosuppression. However, lacking adequate surrogate and response parameters, the most effective biological dosing schedules remain to be defined. Considering these apparent limitations, the full clinical potential of this promising class of drugs is at risk to be missed by applying them inadequately.