Chemotherapy remains the principal treatment strategy for different types of cancer. However, cellular multidrug resistance (MDR) prevents efficient killing of the cancer cells, leading to chemotherapeutic treatment failure. Thus, MDR is one of the major obstacles to the successful chemotherapeutic treatment of cancer patients. MDR phenomenon is known as the resistance of tumor cells to structurally and functionally different cytotoxic or cytostatic anticancer agents. Over-expression of anti-apoptotic factors, under-expression of pro-apoptotic factors, ATP-binding cassette transporters which decrease intracellular drug concentrations to sublethal levels, increase in amount of drug target, changes in the structure of target and aberrant ceramide metabolism confers MDR.

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