The Autophagy Conundrum in Cancer Development, Progression and Therapeutics

Autophagy is an evolutionarily conserved process that delivers intracellular constituents to the lysosomes for degradation and recycling. Autophagy plays a central role in diverse physiological processes and has been implicated in the pathogenesis of various diseases including cancer. The role of autophagy in cancer is complex and largely context-dependent. Accumulating evidence indicates that autophagy facilitates tumorigenesis by enabling acquisition of cancer hallmarks. Autophagy manipulation has emerged as a promising strategy in cancer treatment. In this chapter, we provide an overview of the autophagic process, highlight the autophagy conundrum in cancer, examine the complex and conflicting reports on autophagy in tumour suppression and tumour promotion, as well as the role of autophagy in the acquisition of cancer hallmarks. Finally, from the clinical perspective, we summarise the evidence for autophagy-related genes and proteins as reliable markers of disease severity and prognosis and analyse the efficacy of autophagy manipulation in improving cancer treatment outcomes and circumventing chemoresistance.