Hypoxia–ROS–HSP Triad Axis in Cancer: Mechanisms, Crosstalk, and Therapeutic Implications

Abstract

Cancer remains one of the leading causes of mortality worldwide, accounting for approximately 20% of all deaths and posing a major threat to global health. Mechanistically, tumorigenesis is driven by complex molecular and cellular mechanisms that enable malignant cells to evade current therapeutic interventions, thereby limiting treatment efficacy and contributing to disease progression. Despite extensive efforts to identify and target key molecular regulators and signaling pathways involved in cancer development, effective and durable treatments remain limited for many cancers, underscoring the need for novel treatment strategies. Consequently, diverse therapeutic strategies are being developed to overcome barriers to treatment response, improve clinical outcomes, and extend patient survival. Among emerging therapeutic targets, HSPs have attracted considerable attention because of their critical roles in maintaining proteostasis, promoting tumor cell survival, and facilitating resistance to therapy. In addition to stress adaptation, oxidative stress and hypoxia are key components of the tumor microenvironment that promote malignant progression through extensive crosstalk with oncogenic signaling pathways. Growing evidence indicates that these pathways are highly interconnected and collectively contribute to cancer metastasis and poor clinical outcomes. In this review, we explore the mechanistic interplay among HSPs, reactive oxygen species (ROS), and hypoxia across various cancers, highlight their potential as integrated therapeutic targets, and explore future strategies to develop more effective anticancer interventions.