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30 Among the pathways activated by IR and IGF-1R signaling are the RASRAFMEK1/2extracellular signal-regulated kinase (ERK)-1/2 pathway 34 and the phosphatidylinositol-3-kinase (PI3K)AKTmammalian target of rapamycin (mTOR) pathway, two fundamental pathways for tumor cell proliferation and survival (Figure 2)