Elevated IGF ligands and IGF1R overexpression are linked to increased tumor growth, poor prognosis, and a reduced response to TMZ therapy.287 IGF1R activates key oncogenic pathways, including the PI3K/AKT and RAS/RAF/MAPK pathways, with ligand-driven activation playing a primary role in tumor cell proliferation.288 Targeting IGF signaling has shown therapeutic potential. The gene discussed is PIK3CA; the disease is neoplasm.