The ability of cancer cells to survive and grow despite the presence of drugs designed to kill them.Drug resistance in cancer is the phenomenon where tumor cells survive and proliferate despite exposure to therapeutic agents designed to kill them. It is the primary reason why many initially effective cancer treatments eventually fail, leading to relapse and disease progression. Resistance can be intrinsic, meaning the tumor never responds, or acquired, where it develops after an initial period of response. This adaptability is a hallmark of cancer's evolutionary nature, driven by genetic mutations and selection pressures imposed by treatment.
The concept emerged in the 1940s–1950s with the advent of chemotherapy, when clinicians observed that cancers initially responding to drugs would often recur and no longer respond. The genetic basis was established in the 1970s–1980s with the discovery of specific resistance genes, such as the multidrug resistance transporter P-glycoprotein.
The mechanisms are diverse. Cancer cells can pump the drug out via efflux transporters, inactivate the drug through metabolic enzymes, alter the drug's target so it no longer binds, or repair DNA damage caused by chemotherapy. More fundamentally, tumors are heterogeneous: even before treatment, some cells may harbor mutations that confer resistance. When a drug is applied, it kills sensitive cells but leaves resistant ones to repopulate the tumor, a process akin to natural selection. Recent research, as highlighted in titles like 'Как опухоль выстраивает своё филогенетическое древо' (How a tumor builds its phylogenetic tree), uses genomic sequencing to trace these evolutionary lineages and predict which branches will dominate under therapy.
Understanding resistance guides combination therapy (using multiple drugs with different mechanisms), adaptive dosing strategies, and the development of next-generation inhibitors that target resistant mutations. Genomic profiling of tumors, as in the article 'Генетический атлас предсказывает течение рака молочной железы' (Genetic atlas predicts breast cancer course), helps clinicians choose treatments less likely to encounter pre-existing resistance.
Some cancer cells can enter a dormant, drug-tolerant state, essentially 'hiding' from treatment without genetic changes, only to re-emerge later.











