A Brief Review on Chemoresistance; Targeting Cancer Stem Cells as an Alternative Approach

The acquisition of resistance to traditional chemotherapy and the chemoresistant metastatic relapse of minimal residual disease both play a key role in the treatment failure and poor prognosis of cancer. Understanding how cancer cells overcome chemotherapy-induced cell death is critical to improve patient survival rate. Here, we briefly describe the technical approach directed at obtaining chemoresistant cell lines and we will focus on the main defense mechanisms against common chemotherapy triggers by tumor cells. Such as, the alteration of drug influx/efflux, the enhancement of drug metabolic neutralization, the improvement of DNA-repair mechanisms, the inhibition of apoptosis-related cell death, and the role of p53 and reactive oxygen species (ROS) levels in chemoresistance. Furthermore, we will focus on cancer stem cells (CSCs), the cell population that subsists after chemotherapy, increasing drug resistance by different processes such as epithelial-mesenchymal transition (EMT), an enhanced DNA repair machinery, and the capacity to avoid apoptosis mediated by BCL2 family proteins, such as BCL-XL, and the flexibility of their metabolism. Finally, we will review the latest approaches aimed at decreasing CSCs. Nevertheless, the development of long-term therapies to manage and control CSCs populations within the tumors is still necessary.

Automated summary

The acquisition of resistance to chemotherapy and the chemoresistant metastatic relapse of minimal residual disease have a significant impact on cancer treatment failure and poor prognosis. Understanding how cancer cells become resistant to chemotherapy-induced cell death is crucial for improving patient survival rate. This article provides a brief overview of the technical approach used to obtain chemoresistant cell lines and focuses on the main defense mechanisms employed by tumor cells against common chemotherapy triggers. It also discusses the role of cancer stem cells (CSCs) in increasing drug resistance and reviews the latest strategies for decreasing CSCs. However, long-term therapies to effectively manage and control CSC populations in tumors are still needed.