Insulin-like growth factors 1 and 2 are peptide hormones that primarily signal through the insulin-like growth factor 1 receptor (IGF-1R) and the insulin receptor isoform A (IR-A). The activation of these receptors triggers downstream pathways such as PI3K/AKT and MAPK/ERK, which regulate cell proliferation, survival, and metabolism. In many cancers, elevated levels of IGFs or their receptors contribute to tumor progression and resistance to therapy. By binding to and neutralizing both IGF-1 and IGF-2, xentuzumab aims to block this oncogenic signaling axis.