Environment-mediated drug resistance: a major contributor to minimal residual disease

Nat Rev Cancer. 2009 Sep;9(9):665-74. doi: 10.1038/nrc2714. Epub 2009 Aug 20.


Environment-mediated drug resistance is a form of de novo drug resistance that protects tumour cells from the initial effects of diverse therapies. Surviving foci of residual disease can then develop complex and permanent acquired resistance in response to the selective pressure of therapy. Recent evidence indicates that environment-mediated drug resistance arises from an adaptive, reciprocal signalling dialogue between tumour cells and the surrounding microenvironment. We propose that new therapeutic strategies targeting this interaction should be applied during initial treatment to prevent the emergence of acquired resistance.

Publication types

  • Review

MeSH terms

  • Drug Resistance, Neoplasm*
  • Humans
  • Neoplasm, Residual / pathology*
  • Neoplasms / drug therapy*
  • Neoplasms / pathology*
  • Signal Transduction / drug effects*
  • Stromal Cells / drug effects*
  • Stromal Cells / pathology