Molecular targeting therapy of cancer: drug resistance, apoptosis and survival signal

Cancer Sci. 2003 Jan;94(1):15-21. doi: 10.1111/j.1349-7006.2003.tb01345.x.


Recent progress in the development of molecular cancer therapeutics has revealed new types of antitumor drugs, such as Herceptin, Gleevec, and Iressa, as potent therapeutics for specific tumors. Our work has focused on molecular cancer therapeutics, mainly in the areas of drug resistance, apoptosis and apoptosis resistance, and survival-signaling, which is related to drug resistance. In this review, we describe our research on molecular cancer therapeutics, including molecular mechanisms and therapeutic approaches. Resistance to chemotherapeutic drugs is a principal problem in the treatment of cancer. P-Glycoprotein (P-gp), encoded by the MDR1 gene, is a multidrug transporter and has a major role in multidrug resistance (MDR). Targeting of P-gp by small-molecular compounds and/or antibodies is an effective strategy to overcome MDR in cancer, especially hematologic malignancies. Several P-gp inhibitors have been developed and are currently under clinical phased studies. In addition to the multidrug transporter proteins, cancer cells have several drug resistance mechanisms. Solid tumors are often placed under stress conditions, such as glucose starvation and hypoxia. These conditions result in topo II poison resistance that is due to proteasome-mediated degradation of DNA topoisomerases. Proteasome inhibitors effectively prevent this stress-induced drug resistance. Glyoxalase I, which is often elevated in drug- and apoptosis-resistant cancers, offers another possibility for overcoming drug resistance. It plays a role in detoxification of methylglioxal, a side product of glycolysis, which is highly reactive with DNA and proteins. Inhibitors of glyoxalase I selectively kill drug-resistant tumors that express glyoxalase I. Finally, the susceptibility of tumor cells to apoptosis induced by antitumor drugs appears to depend on the balance between pro-apoptotic and survival (anti-apoptotic) signals. PI3K-Akt is an important survival signal pathway, that has been shown to be the target of various antitumor drugs, including UCN-01 and geldanamycin, new anticancer drugs under clinical evaluation. Our present studies provide novel targets for future effective molecular cancer therapeutics.

Publication types

  • Review

MeSH terms

  • 3-Phosphoinositide-Dependent Protein Kinases
  • ATP Binding Cassette Transporter, Subfamily B, Member 1 / antagonists & inhibitors
  • ATP Binding Cassette Transporter, Subfamily B, Member 1 / physiology
  • Antineoplastic Agents / pharmacology*
  • Apoptosis / drug effects*
  • Apoptosis / physiology
  • Biological Transport / drug effects
  • Cell Hypoxia
  • Cell Nucleus / enzymology
  • Cell Survival
  • Cysteine Endopeptidases / physiology
  • Drug Design*
  • Drug Resistance, Multiple* / genetics
  • Drug Resistance, Neoplasm* / genetics
  • HSP90 Heat-Shock Proteins / antagonists & inhibitors
  • HSP90 Heat-Shock Proteins / physiology
  • Humans
  • Lactoylglutathione Lyase / antagonists & inhibitors
  • Lactoylglutathione Lyase / physiology
  • Multienzyme Complexes / physiology
  • Neoplasm Proteins / antagonists & inhibitors
  • Neoplasm Proteins / physiology
  • Neoplasms / drug therapy*
  • Neoplasms / metabolism
  • Oxidative Stress
  • Protease Inhibitors / pharmacology
  • Protease Inhibitors / therapeutic use
  • Proteasome Endopeptidase Complex
  • Protein-Serine-Threonine Kinases / antagonists & inhibitors
  • Protein-Serine-Threonine Kinases / physiology
  • Proto-Oncogene Proteins / antagonists & inhibitors
  • Proto-Oncogene Proteins / physiology
  • Proto-Oncogene Proteins c-akt
  • Signal Transduction / drug effects


  • ATP Binding Cassette Transporter, Subfamily B, Member 1
  • Antineoplastic Agents
  • HSP90 Heat-Shock Proteins
  • Multienzyme Complexes
  • Neoplasm Proteins
  • Protease Inhibitors
  • Proto-Oncogene Proteins
  • 3-Phosphoinositide-Dependent Protein Kinases
  • AKT1 protein, human
  • Protein-Serine-Threonine Kinases
  • Proto-Oncogene Proteins c-akt
  • Cysteine Endopeptidases
  • Proteasome Endopeptidase Complex
  • Lactoylglutathione Lyase