Tanshinone IIA in breast cancer: Molecular mechanisms, structural optimization and translational challenges (Review)

Tanshinone IIA (Tan IIA), a lipophilic abietane‑type diterpenoid isolated from Salvia miltiorrhiza, exhibits a set of mechanistic features that distinguish it from numerous other natural products. Recent studies in breast cancer models have revealed that Tan IIA not only induces apoptosis but also targets several cancer‑relevant vulnerabilities, including the stabilization of G‑quadruplex (G4) DNA structures, the disruption of mitochondrial oxidative phosphorylation and the inhibition of estrogen receptor α/human epidermal growth factor receptor 2‑driven signaling. Tan IIA further modulates epigenetic regulators such as lysine demethylase 1A and promotes ferroptosis by disturbing redox homeostasis. These mechanisms support the multifaceted anticancer potential of Tan IIA; however, their relative contribution appears to be highly dependent on concentration, formulation, derivative structure and breast cancer subtype. Nevertheless, Tan IIA suffers from poor aqueous solubility, rapid metabolic conversion and low oral bioavailability, reported to be ~2‑6% in rats, which hinder its translational prospects. Recent efforts involving structural optimization and nanoscale delivery systems have partially addressed these limitations. Overall, this review integrates current mechanistic and pharmacological evidence and highlights both the therapeutic promise and the critical barriers that must be overcome for the successful development of Tan IIA‑based interventions in breast cancer. High‑micromolar in vitro findings, particularly those related to reactive oxygen species‑dependent cytotoxicity, ferroptosis or G4 stabilization, should be interpreted cautiously unless supported by pharmacokinetic, tumor‑exposure and in vivo target‑engagement data.