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Zhang C, Wang G, Xu J, Wang W, Sun P, Hu S. A review of the role of CSCs and CSC-EXOs in increasing drug resistance in breast cancer and future applications. Crit Rev Oncol Hematol 2025; 212:104774. [PMID: 40412576 DOI: 10.1016/j.critrevonc.2025.104774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2025] [Revised: 05/04/2025] [Accepted: 05/19/2025] [Indexed: 05/27/2025] Open
Abstract
Breast cancer (BCa) remains a major global health challenge due to its complex etiology, varied clinical manifestations, and therapy resistance, which contributes to nearly 90 % of cancer-related deaths. A key factor in treatment failure is the presence of BCa stem cells (BCSCs), which drive drug resistance and tumor recurrence. Understanding BCSC formation, regulation, and role in therapeutic resistance is crucial for developing targeted therapies. Additionally, exosomes (EXOs) secreted by BCSCs play a critical role in cancer progression and drug resistance. These vesicles facilitate communication between cancer and stromal cells by transferring RNA and proteins, influencing treatment response. For instance, EXOs from stromal cells can enhance BCa cell survival under chemotherapy and radiation. This study explores BCSC mechanisms, their contribution to drug resistance, and emerging therapeutic strategies. We also examine how BCa-derived and BCSC-derived EXOs promote drug tolerance and tumor growth. Finally, we discuss future treatment approaches, current research limitations, and potential solutions to advance BCa therapy. Novel interventions may overcome resistance and improve patient outcomes by targeting BCSCs and EXO-mediated pathways. However, further research is needed to translate these findings into practical clinical applications.
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Affiliation(s)
- Chen Zhang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Liver Transplant Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Guoliang Wang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Liver Transplant Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jianjun Xu
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Liver Transplant Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wenqiang Wang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Liver Transplant Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ping Sun
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Shaobo Hu
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Liver Transplant Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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