IAPs in cancers: molecular mechanisms, clinical prognostic value, and translational therapeutic potential

BACKGROUND: Conventional therapies remain the primary approach for most cancers but typically achieve only modest improvements in prognosis. With the rapid advances in molecular biology and multi-omics technologies, targeted therapy has become the first choice for treating advanced cancer. Among these, inhibitor of apoptosis proteins (IAPs) has emerged as critical regulators in both experimental and clinical studies. MAIN BODY: Nevertheless, several challenges persist, including tumor heterogeneity across cancer types, adverse effects associated with IAPs inhibitors (such as cytokine release and inflammation), and the lack of validated biomarkers for patient selection. With the development of artificial intelligence and precision medicine, IAP-targeted therapy, especially in combination with other therapies, has shown favorable clinical application potential. CONCLUSIONS: This review systematically summarizes the structural domains, molecular functions, biological processes, clinical relevance, and advances in drug development and translational applications of IAPs, aiming to refine therapeutic strategies and facilitate clinical translation.