Mecanismos del ciclo celular y la apoptosis implicados en las resistencias a los fármacos de uso intravesical en el cáncer superficial de vejiga

it is well documented the effectiveness of intravesical chemotherapy following transurethral resection to prevent recurrences of superficial bladder cancer. but it is also known that efficacy may be limited by tumour cell resistance to one or several of the drugs available for instillation. in addition to the genetically determined unicellular mechanisms classically described in the literature such as glycoprotein p-170 expression (mdr-1), overexpression of bcl-2 or glutation s-transferase activity, it has been recently shown that multicellular mechanisms may also be involved in drug resistance. multicellular resistance can only be demonstrated in three-dimensional cultures and fails to be shown in monolayers or cell suspensions. this is explained by the fact that cell-to-cell and cell-to-stroma adhesion limits drug penetration and by the variable susceptibility to cytotoxicity determined by oxygen and tissue proliferation gradients. a better understanding of the molecular mechanisms involved in drug resistance is necessary to increase intravesical chemotherapy effectiveness. current research includes improving drug penetration, searching resistance reversing agents and developing in vitro chemosensitivity tests to identify drug resistance.