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  • Review Article
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Translating ferroptosis into oncology: challenges, opportunities and future directions

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Abstract

Ferroptosis is an oxidative, lipid peroxidation-driven form of regulated cell death that occurs when antioxidant and organelle-protective systems are compromised. Increasing evidence implicates ferroptosis as a process that can exert both tumour-suppressive and tumour-promoting effects depending on cellular context at multiple stages of cancer evolution (from tumour initiation to metastatic colonization), sparking substantial interest in therapeutically exploiting this mechanism of cell death. Yet, despite rapid preclinical progress, clinical translation of ferroptosis-based strategies remains nascent. In this Review, we examine the major barriers to translation, including pharmacological limitations, tumour-intrinsic heterogeneity, microenvironmental and immune constraints, and gaps in current preclinical modelling. We also highlight emerging opportunities such as new ferroptosis-inducing agents, biomarker-guided patient selection and rational combinations with chemotherapy, radiotherapy, targeted agents or immunotherapies. Finally, we outline a translational roadmap for integrating ferroptosis-based therapies into oncology practice. By defining key challenges and future directions, this Review aims to position ferroptosis as a viable therapeutic paradigm and to accelerate progress towards clinical application.

Key points

  • Ferroptosis is a lipid peroxidation-driven cell death process shaped by antioxidant, metabolic and organelle-protective pathways, highlighting the adaptive plasticity that cancer cells use to maintain redox homeostasis.

  • Tumour-intrinsic heterogeneity, including variable genetic, metabolic, epigenetic and lineage programmes, creates diverse ferroptosis sensitivities, reinforcing the need for biomarker-guided patient selection rather than uniform therapeutic strategies.

  • The tumour microenvironment, including stromal buffering, hypoxia, acidosis, immune cell vulnerability and microbiota-derived metabolites, profoundly modulates ferroptosis, making therapeutic induction inherently context dependent.

  • First-generation ferroptosis inducers have limited drug-like properties, whereas new agents, including GPX4 and FSP1 inhibitors, degraders, prodrugs, nanocarriers and antibody–drug conjugates, offer improved potency and tumour selectivity.

  • Integrated genomic, transcriptomic, lipidomic and imaging biomarkers, including ACSL4, TFRC, various damage-associated molecular patterns and ferroptosis-focused PET probes, are essential for predicting ferroptosis sensitivity and pharmacodynamic monitoring pathway modulation.

  • Rational combinations of ferroptosis inducers with immunotherapy, radiotherapy, targeted therapies and metabolic inhibitors can exploit ferroptosis vulnerabilities to overcome therapeutic resistance and improve efficacy but require careful calibration to avoid immune or non-malignant tissue toxicity.

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Fig. 1: Key metabolic, organellar and signalling networks governing ferroptosis in cancer cells.
Fig. 2: Regulation of GPX4 stability and activity in tumour ferroptosis.
Fig. 3: Microenvironmental and immune determinants of ferroptosis sensitivity in cancer.
Fig. 4: Stage-specific roles of ferroptosis throughout tumour evolution.

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Acknowledgements

The authors thank the many pioneers in the field and colleagues whose work has shaped current understanding of ferroptosis.

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D.T. conceived and supervised the overall framework of the Review. All authors contributed substantially to discussions of content, writing, and review and editing of all sections of the manuscript.

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Correspondence to Rui Kang, Jiao Liu, Jiayi Wang, Guido Kroemer or Daolin Tang.

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Competing interests

G.K. declares research contracts with Daiichi Sankyo, Eleor, Kaleido Biosciences, Lytix Pharma, PharmaMar, Osasuna Therapeutics, Samsara Therapeutics, Sanofi, Sutro Biopharma, Tollys and VASCage; serves on the Board of Directors of the Bristol Myers Squibb Foundation France, and on scientific advisory boards for Hevolution, Institut Servier, Longevity Vision Funds and Rejuveron Life Sciences/Centenara Labs; is a scientific co-founder of everImmune, Osasuna Therapeutics, Samsara Therapeutics and Therafast Bio; and is the inventor of patents covering therapeutic targeting of ageing, cancer, cystic fibrosis and metabolic disorders, including one, ‘Methods for weight reduction’ (US11905330B1), relevant to this work. G.K.’s brother, Romano Kroemer, was an employee of Sanofi and now consults for Boehringer-Ingelheim. G.K.’s wife, Laurence Zitvogel, has held research contracts with GSK, Incyte, Lytix Pharma, Kaleido Biosciences, Innovate Pharma, Daiichi Sankyo, PiLeJe, Merus, Transgene SA, 9M Life Sciences, Tusk Therapeutic and Roche; was on the Board of Directors of Transgene SA; is a cofounder of everImmune; and holds patents covering the treatment of cancer and the therapeutic manipulation of the microbiota. The other authors declare no competing interests.

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Nature Reviews Clinical Oncology thanks E. Catanzaro, X. Chen, F. Wang and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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US NIH ClinicalTrials.gov database: https://www.clinicaltrials.gov

US NIH PubChem database: https://pubchem.ncbi.nlm.nih.gov/

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Kang, R., Liu, J., Wang, J. et al. Translating ferroptosis into oncology: challenges, opportunities and future directions. Nat Rev Clin Oncol (2026). https://doi.org/10.1038/s41571-026-01128-z

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