Mechanistic insights into the roles of astragalosides and Astragalus polysaccharides in gynecological and breast cancers (Review)

Astragalus membranaceus, a Qi‑tonifying herb widely used in traditional Chinese medicine, has emerged as a promising adjuvant for female‑predominant malignancies, including breast, ovarian and cervical cancers. Its major bioactive constituents, Astragalus polysaccharides (APS) and astragalosides (AST), exert multitarget antitumor activities and are widely used as complementary agents in clinical oncology. Nevertheless, key mechanistic gaps persist, particularly regarding the crosstalk among the PI3K/Akt/mTOR, Wnt/β‑catenin, JNK/MAPK and TGF‑β/Smad pathways, as well as the subtype‑ and context‑dependent regulation of molecular effectors governing programmed cell death, epithelial‑mesenchymal transition and immune reprogramming. This uncertainty constrains biomarker discovery and the rational design of combination regimens, thereby limiting the predictability of clinical benefit. The present review systematically collates current research on the molecular mechanisms and signaling networks through which APS and AST modulate breast, ovarian and cervical cancer biology. Available data indicate that these compounds suppress tumor initiation and progression by inhibiting proliferation, inducing programmed cell death, attenuating invasion and metastasis, reshaping antitumor immunity and macrophage polarization, and potentiating chemotherapeutic efficacy while mitigating treatment‑related toxicity. Overall, these insights aim to provide a mechanistic rationale for the clinical integration of A. membranaceus as an adjuvant therapy in gynecological and breast cancers, to bridge traditional Chinese medicine with contemporary pharmacology, and to support the development of individualized, integrative therapeutic strategies for breast, ovarian and cervical cancers.