Alteration of target or transport mechanisms

Tumour cells have the ability to mutate such that the drug is either not taken up by the cell or having been taken up is detoxified more rapidly than normal. Alternatively, the actual target of the drug may change by mutation such that it becomes impervious to the form of attack. Or the normal repair mechanisms which are present in all mammalian cells may become more active and repair damage is produced by a cytotoxic agent in a more efficient manner, resulting in overall resistance to the agent.

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