Breast cancer is the most prevalent cancer in women. Despite improvements in treatment, the rate of breast cancer-related deaths is still high, and this issue needs further, accurate investigations. Although several treatment options are available, none of them are efficient for complete remission, particularly in advanced stages of the disease. It is known that cancerous cells have dysregulated apoptosis-related pathways, by which they can remain alive for a long time, expand freely, and escape from apoptosis-inducing drugs or antitumor immune responses. Therefore, modulation of apoptosis resistance in cancer cells may be an efficient strategy to overcome current problems faced in the development of immunotherapeutic approaches for the treatment of breast cancer. The inhibitors of apoptosis protein (IAPs) are important targets for cancer therapy because it has been shown that these molecules are overexpressed and highly active in various cancer cells and suppress apoptosis process in malignant cells by blockage of caspase proteins. There is evidence of Smac mimetics efficacy as a single agent; however, recent studies have indicated the efficacy of current anticancer immunotherapeutic approaches when combined with Smac mimetics, which are potent inhibitors of IAPs and synthesized mimicking Smac/Diablo molecules. In this review, we are going to discuss the efficacy of treatment of breast cancer by Smac mimetics alone or in combination with other therapeutics. K E Y W O R D S apoptosis, breast cancer, Smac mimetic, treatment 1 | INTRODUCTION Because of the high prevalence of the breast cancer among women, it is considered one of the main public healthrelated problems worldwide. There are several risk factors forbreast cancer, such as obesity, alcohol consumption, ionizing radiation, lack of physical exercise, early age menstruation, and family history. 1 Inheritance of genes such as BRCA1 and BRCA2 is another risk factor that affects about 5% to 10% of the subjects. More than 20 breast cancer subtypes have been J Cell Biochem. 2019;120:9300-9314. wileyonlinelibrary.com/journal/jcb 9300 |