The tumor microenvironment (TME) promotes the malignant transformation of
cancer cells, mainly through metabolic reprogramming. As one of the most prominent features of the TME,
hypoxia contributes to
cancer cell death resistance, invasion,
metastasis, and
therapy-resistant phenotypes. As an important cofactor for various
enzymes,
iron is essential for
ATP generation,
antioxidant protein function, and DNA-damage repair in hypoxic
cancer cells.
Iron metabolism, as a promoter of aggressive hypoxic
cancer cell biology, has attracted an increasing amount of attention.
Iron utilization, storage, and efflux are enhanced in hypoxic
cancer cells, which further contributes to
cancer cell proliferation,
metastasis, ferroptosis resistance, and immune escape. This review describes the relationship between
iron metabolism and proliferation,
metastasis, and ferroptosis of hypoxic
cancer cells, as well as several
iron-targeted
cancer therapy strategies. Understanding the
hypoxia-specific regulatory mechanism of
iron metabolism could aid the development of targeted
therapy against refractory hypoxic
cancer cells.