Abstract Breast cancer (BC) continues to pose a substantial clinical challenge due to acquired resistance induced by epithelial-mesenchymal transition (EMT). Nevertheless, this adaptive evolution, which frequently takes the form of a highly plastic, partial EMT (p-EMT) state, induces a profound lipidomic reconfiguration and iron dysregulation, thereby inadvertently revealing a targetable metabolic vulnerability: ferroptosis. In this Perspective, we outline the hierarchical molecular logic that governs this susceptibility, emphasizing the manner in which progressive p53 mutations (ranging from loss-of-function to gain-of-function) transform p-EMT cells from passive sensitization to an extreme “metabolic addiction.” We argue that conventional “occupancy-driven” kinase inhibitors are unable to eliminate these resistant populations because they are unable to dismantle the essential non-catalytic scaffolding functions of core EMT-induced kinases (EIKs). As a result, we suggest a paradigm shift toward a chemical biology approach that is “event-driven.” The p-EMT infrastructure can be irreversibly destroyed and resistant cells can be compelled to undergo catastrophic lipid peroxidation by deploying proteolysis targeting chimeras (PROTACs) against concealed scaffold super-hubs, particularly AXL and lemur tail kinase 3 (LMTK3), which are indispensable for stabilizing the hybrid p-EMT infrastructure. Additionally, we investigate the spatiotemporal modulation of this synthetic lethal axis by the tumor microenvironment (TME) through matrix mechanics and extracellular vesicles (EVs). Ultimately, we suggest a multimodal liquid biopsy strategy that couples specific oxidized phospholipid signatures with circulating tumor DNA (ctDNA) kinetics to precisely monitor in vivo ferroptotic events. This approach offers a transformative roadmap for eradicating minimal residual disease (MRD) and surmounting BC dormancy.
Lu et al. (Sat,) studied this question.