Cellular senescence in cancer: from mechanism paradoxes to precision therapeutics

Abstract Cellular senescence is a double-edged sword in cancer biology, functioning as both a tumor-suppressive mechanism and a driver of malignancy. Initially, senescence acts as a protective barrier by arresting the proliferation of damaged or oncogene-expressing cells via pathways such as oncogen...

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Main Authors: Tiejun Feng, Fuda Xie, Leo M.Y. Lee, Zhiqiang Lin, Yifan Tu, Yang Lyu, Peiyao Yu, Jialin Wu, Bonan Chen, Ge Zhang, Gary M.K. Tse, Ka Fai To, Wei Kang
Format: Article
Language:English
Published: BMC 2025-08-01
Series:Molecular Cancer
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Online Access:https://doi.org/10.1186/s12943-025-02419-2
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author Tiejun Feng
Fuda Xie
Leo M.Y. Lee
Zhiqiang Lin
Yifan Tu
Yang Lyu
Peiyao Yu
Jialin Wu
Bonan Chen
Ge Zhang
Gary M.K. Tse
Ka Fai To
Wei Kang
author_facet Tiejun Feng
Fuda Xie
Leo M.Y. Lee
Zhiqiang Lin
Yifan Tu
Yang Lyu
Peiyao Yu
Jialin Wu
Bonan Chen
Ge Zhang
Gary M.K. Tse
Ka Fai To
Wei Kang
author_sort Tiejun Feng
collection DOAJ
description Abstract Cellular senescence is a double-edged sword in cancer biology, functioning as both a tumor-suppressive mechanism and a driver of malignancy. Initially, senescence acts as a protective barrier by arresting the proliferation of damaged or oncogene-expressing cells via pathways such as oncogene-induced senescence and the DNA damage response. However, persistent senescence-associated secretory phenotype and metabolic reprogramming in senescent cells create a pro-inflammatory, immunosuppressive tumor microenvironment, fueling cancer progression, therapy resistance, and metastasis. This comprehensive review systematically examines the molecular mechanisms of senescence across diverse cancers, spanning digestive, reproductive, urinary, respiratory, nervous, hematologic, endocrine, and integumentary systems, and elucidates its context-dependent roles in tumor suppression and promotion. We highlight groundbreaking therapeutic innovations, including precision senolytics, senomorphics, and combinatorial strategies integrating immunotherapy, metabolic interventions, and epigenetic modulators. The review also addresses microenvironment remodeling and cutting-edge technologies for dissecting senescence heterogeneity, epigenetic clocks for biological age prediction, and microbiome engineering to modulate senescence. Despite their promise, challenges such as off-target effects, biomarker limitations, and cellular heterogeneity underscore the need for precision medicine approaches. Finally, we propose future directions to harness senescence as a dynamic therapeutic target, offering transformative potential for cancer treatment.
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spelling doaj-art-4db34aa74fff40769484b416cfcd74c62025-08-20T03:45:48ZengBMCMolecular Cancer1476-45982025-08-0124113410.1186/s12943-025-02419-2Cellular senescence in cancer: from mechanism paradoxes to precision therapeuticsTiejun Feng0Fuda Xie1Leo M.Y. Lee2Zhiqiang Lin3Yifan Tu4Yang Lyu5Peiyao Yu6Jialin Wu7Bonan Chen8Ge Zhang9Gary M.K. Tse10Ka Fai To11Wei Kang12Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, Sir Y.K. Pao Cancer Center, The Chinese University of Hong KongDepartment of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, Sir Y.K. Pao Cancer Center, The Chinese University of Hong KongDepartment of Applied Biology and Chemical Technology, The Hong Kong Polytechnic UniversityNational Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Southern University of Science and TechnologyDepartment of Obstetrics and Gynaecology, The Chinese University of Hong KongDepartment of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, Sir Y.K. Pao Cancer Center, The Chinese University of Hong KongDepartment of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, Sir Y.K. Pao Cancer Center, The Chinese University of Hong KongDepartment of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, Sir Y.K. Pao Cancer Center, The Chinese University of Hong KongDepartment of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, Sir Y.K. Pao Cancer Center, The Chinese University of Hong KongLaw Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases (TMBJ), School of Chinese Medicine, Hong Kong Baptist UniversityDepartment of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, Sir Y.K. Pao Cancer Center, The Chinese University of Hong KongDepartment of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, Sir Y.K. Pao Cancer Center, The Chinese University of Hong KongDepartment of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, Sir Y.K. Pao Cancer Center, The Chinese University of Hong KongAbstract Cellular senescence is a double-edged sword in cancer biology, functioning as both a tumor-suppressive mechanism and a driver of malignancy. Initially, senescence acts as a protective barrier by arresting the proliferation of damaged or oncogene-expressing cells via pathways such as oncogene-induced senescence and the DNA damage response. However, persistent senescence-associated secretory phenotype and metabolic reprogramming in senescent cells create a pro-inflammatory, immunosuppressive tumor microenvironment, fueling cancer progression, therapy resistance, and metastasis. This comprehensive review systematically examines the molecular mechanisms of senescence across diverse cancers, spanning digestive, reproductive, urinary, respiratory, nervous, hematologic, endocrine, and integumentary systems, and elucidates its context-dependent roles in tumor suppression and promotion. We highlight groundbreaking therapeutic innovations, including precision senolytics, senomorphics, and combinatorial strategies integrating immunotherapy, metabolic interventions, and epigenetic modulators. The review also addresses microenvironment remodeling and cutting-edge technologies for dissecting senescence heterogeneity, epigenetic clocks for biological age prediction, and microbiome engineering to modulate senescence. Despite their promise, challenges such as off-target effects, biomarker limitations, and cellular heterogeneity underscore the need for precision medicine approaches. Finally, we propose future directions to harness senescence as a dynamic therapeutic target, offering transformative potential for cancer treatment.https://doi.org/10.1186/s12943-025-02419-2SenescenceCancerTherapeutic innovation
spellingShingle Tiejun Feng
Fuda Xie
Leo M.Y. Lee
Zhiqiang Lin
Yifan Tu
Yang Lyu
Peiyao Yu
Jialin Wu
Bonan Chen
Ge Zhang
Gary M.K. Tse
Ka Fai To
Wei Kang
Cellular senescence in cancer: from mechanism paradoxes to precision therapeutics
Molecular Cancer
Senescence
Cancer
Therapeutic innovation
title Cellular senescence in cancer: from mechanism paradoxes to precision therapeutics
title_full Cellular senescence in cancer: from mechanism paradoxes to precision therapeutics
title_fullStr Cellular senescence in cancer: from mechanism paradoxes to precision therapeutics
title_full_unstemmed Cellular senescence in cancer: from mechanism paradoxes to precision therapeutics
title_short Cellular senescence in cancer: from mechanism paradoxes to precision therapeutics
title_sort cellular senescence in cancer from mechanism paradoxes to precision therapeutics
topic Senescence
Cancer
Therapeutic innovation
url https://doi.org/10.1186/s12943-025-02419-2
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