Multidrug resistance, inherent or acquired, is a frequent characteristic of cancer cells and is difficult to predict and to manage. It is caused by multiple mechanisms, including the dysfunctional metabolism of the lipid second messenger ceramide. The cytotoxic effect of various chemotherapeutics is decreased when the generation of ceramides is impaired, which results in the ineffectiveness of routine dosage and the need for higher, even more toxic drug levels. Needless to emphasize, this is a most undesirable situation; patients and oncologists would welcome its possible correction.
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