Abnormalities in the PI3K/Akt/mTOR intracellular signalling pathway have been implicated in several forms of human cancer. The central component of the pathway is the phosphatidylinositol 3-kinase (PI3K) heterodimer which comprises the p85 regulatory and p110 catalytic subunit, and mutations in the catalytic domain of PI3K have been identified in 20–25% of breast cancers [1, 2]. A further 15–35% of breast cancer patients demonstrate reduced expression of PTEN (phosphatase and tensin homologue deleted on chromosome ten), an endogenous inhibitor of the PI3K/AKT pathway [3]. Akt is the ultimate effector of the pathway and directs a multitude of intracellular effects related to growth, glucose metabolism, protein synthesis and cell survival. Activation of the PI3K/Akt pathway provides a cell with unrestricted growth and survival signals, and one important downstream consequence is the alleviation of the suppression by the tuberous sclerosis protein complex (TSC1/2) of the mammalian target of rapamycin (mTOR) [4]. There are at least two groups of mTOR proteins, and the key protein involved in transmitting signals from PI3K/Akt is the mTORC1 complex. Within cells, mTORC1 plays a critical role in the transduction of proliferative signals through phosphorylation of the translational regulator 4E-BP1 (eukaryotic initiation factor 4E-binding protein) and the ribosomal protein p70 (the 70-kDa S6 kinase) that facilitate translation of mRNAs into proteins [5, 6]. In recent years our understanding of this pathway in breast cancer has been exploited by the development of a number of targeted anti-cancer therapeutics, with mTOR inhibitors being the most clinically developed to date. Rapamycin is the original inhibitor of mTOR that was found to be a potent fungicide with immunosuppressive properties, and therapeutics were developed for clinical use in transplantation to prevent graft rejection. Subsequently rapamycin was found to have anti-proliferative effects in a range of experimental tumours [7], and rapamycin analogues with a more favourable pharmacological profile were synthesised including CCI-779 (temsirolimus), RAD001 (everolimus) and AP23573 (ridaforolimus). In various breast cancer cell lines with constitutive activation of the PI3K/Akt pathway due to either HER2 amplification, ER activation or PTEN deletions temsirolimus showed specific sensitivity [8], whilst everolimus (an oral hydroxyethyl ether of rapamycin) demonstrated impressive anti-proliferative activity against a wide variety of tumour models in vivo [9]. In the clinic mTOR antagonists were found to be relatively well tolerated in early phase I/II trials [10, 11], and development programmes were established in various solid malignancies, in particular renal cell cancer and breast cancer. But has the development of mTOR antagonists for breast cancer moved ahead too fast before it was really appreciated how best to utilise these drugs as targeted therapeutics? As a single agent temsirolimus showed only modest activity in the advanced breast cancer setting [12], and subsequently both temsirolimus and everolimus were developed in combination with endocrine therapy following encouraging evidence for additive or synergistic effects from several pre-clinical models of endocrine resistant breast cancer [13, 14]. However, results from randomised clinical trials of mTOR antagonists in combination with This is an invited commentary to articles doi: 10.1007/s10549-010-0967-z, 10.1007/s10549-010-0986-9, 10.1007/s10549-010-1058-x.