Narrative reviewindependent cross-checkabstract checked I-CHM-119 standard review
Tumour surroundings can protect cancer cells from drugs
Environment-mediated drug resistance: a major contributor to minimal residual disease.
Overview
Meads MB et al.. Nat Rev Cancer 2009 · PMID 19693095 · DOI 10.1038/nrc2714
Signals between cancer cells and their surroundings can make some cells resist treatment at first.
Does the study support the specific claim? Partly · Methodological quality: low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Review resistance caused by the tumour environment
- How was the study done?
Narrative review
- How many people, animals or samples were studied?
Not applicable
- What was actually found?
Environment can protect cancer cells
- How large was the observed effect?
Not applicable
- What do the results mean in everyday life?
One reason some cancer cells survive treatment
- What are the study's limitations?
Narrative; mostly lab evidence
- What does it say about Elawady's specific claim?
Partly supports the mechanism; authors recommend better treatment, not none
- Do the results apply to Germany and Europe?
Moderate
- What can explicitly not be concluded from this study?
Cannot support avoiding treatment
Scientific in-depth review
1. Full reference
- Authors
- Meads MB et al.
- Journal
- Nat Rev Cancer
- Year
- 2009
- Identifier
- PMID 19693095 DOI 10.1038/nrc2714
- Verification
- verified – PubMed efetch 2026-10-26 (PublicationType and CommentsCorrections checked); Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Not stated in abstract.
2. Research question
How does the tumour microenvironment confer drug resistance?
3. Study design and population
- Study design
- Narrative review – Narrative review
- Population
Not applicable
- Country
Not applicable
- Period
Not applicable
- Sample size
Not applicable
- Inclusion and exclusion criteria
Not applicable
4. Methods and endpoints
- Exposure / intervention
Tumour microenvironment
- Comparator
Not applicable
- Endpoints
Drug resistance mechanisms
- Statistical methods
Not applicable
5. Actual results
- Results
Describes environment-mediated drug resistance as de novo resistance protecting tumour cells from initial therapy through reciprocal signalling between tumour and microenvironment; surviving residual disease can then develop acquired resistance.
- Absolute risks
not applicable
- Authors' conclusion
New strategies targeting tumour-microenvironment interaction should be applied during initial treatment.
6. Strengths
- Influential synthesis by experts
7. Weaknesses
- Narrative, not systematic
- Largely preclinical evidence
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Narrative review.
9. Assessment of the statistical interpretation
Not applicable.
10. Relevance to the specific claim
Supports the narrow part of C-CHM-11: the tumour microenvironment (including stroma) can protect cancer cells from drugs.
11. Independent contrary findings
HALO-301 (I-CHM-118) and Rhim 2014 (I-CHM-117).
12. Transferability to Germany and Europe
Basic biology.
13. Overall methodological judgement
Plausible mechanism; not a reason to avoid treatment (the authors propose adding microenvironment-targeted therapy to treatment).
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | low |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | indirect |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | mixed |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Clinical relevance across cancers.