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DNA Repair Pathways in Cancer Therapy and Resistance
Open accessAbstract
DNA repair pathways are triggered to maintain genetic stability and integrity when mammalian cells are exposed to endogenous or exogenous DNA-damaging agents. The deregulation of DNA repair pathways is associated with the initiation and progression of cancer. As the primary anti-cancer therapies, ionizing radiation and chemotherapeutic agents induce cell death by directly or indirectly causing DNA damage, dysregulation of the DNA damage response may contribute to hypersensitivity or resistance of cancer cells to genotoxic agents and targeting DNA repair pathway can increase the tumor sensitivity to cancer therapies. Therefore, targeting DNA repair pathways may be a potential therapeutic approach for cancer treatment. A better understanding of the biology and the regulatory mechanisms of DNA repair pathways has the potential to facilitate the development of inhibitors of nuclear and mitochondria DNA repair pathways for enhancing anticancer effect of DNA damage-based therapy.
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“One possible explanation for the observed difference between cSNVs and dbSNVs could be system-wide alterations in cancer cells, which are often characterized by increased replication stress, altered DNA repair mechanisms or changes in chromatin structure (85,86).”
From G-quadruplex-mediated genomic instability drives SNVs in cancer (2024) · cites this paper as [86]
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“DNA repair systems play a major role in maintaining genome stability; therefore, the proteins of these systems are used as targets for anticancer therapy [5–9].”
BackgroundExogenous Metabolic Modulators Improve Response to Carboplatin in Triple-Negative Breast Cancer
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“In contrast, cancer cells have a dysregulated DNA damage response; thus, CP-induced DSBs inhibit DNA replication and transcription, ultimately resulting in cancer cell apoptosis and tumor shrinkage [8–10].”
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BackgroundRadiation-induced rescue effect on human breast carcinoma cells is regulated by macrophages
Pathikonda, S., Tian, L., Arava, C. M., Cheng, S. H., & Lam, Y. W. (2025) · Biochemistry and Biophysics Reports · doi:10.1016/j.bbrep.2025.101936 · Cited by 1
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Treatment failure shortcomings, possible causes and upcoming phyto-optimism in oral cancer
Mishra, R. (2023) · The Applied Biology & Chemistry Journal · doi:10.52679/tabcj.2023.0002 · Cited by 2
Jeon, S. H., & Chie, E. (2023) · Cancer Medicine · doi:10.1002/cam4.5586 · Cited by 2
Le, H., Steenwyk, J. L., Manske, N., Smolin, M., Abdulali, A., Kamat, A., Kanchana, R., Giffin, K., Andere, A., & Workman, K. (2022) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2022.11.10.516016 · Cited by 2
“Interestingly, DNA damage response genes are known to be down-regulated in colorectal cancer cells, which can be exploited for cancer therapies [29, 30].”
BackgroundA Perspective on Studies of Phage DNA Packaging Dynamics
Serwer, P. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23147854 · Cited by 2
Singh, S., Singh, N., Baranwal, M., & Sharma, S. (2022) · American Journal of the Medical Sciences · doi:10.1016/j.amjms.2022.07.005 · Cited by 2
The Role p53 Protein in DNA Repair
Bakhanashvili, M. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.99051 · Cited by 2
Ji, T.-T., Xu, Z., Zhou, Y., Yu, W., Li, T., Yang, Y., & Hong, B. (2025) · Radiation Physics and Chemistry · doi:10.1016/j.radphyschem.2024.112415 · Cited by 2
Dynamic monitoring of chemoresistant tumor cells enabled by an adaptive DNA nanoclassifier
Zhou, X.-M., Tao, X.-L., Lei, Y.-M., Yang, X., & Zhuo, Y. (2026) · Science China Chemistry · doi:10.1007/s11426-026-3541-7 · Cited by 1
Nagappan, A., Sethuraman, V., Parthiban, P., Nedunchezhian, J., & Shukla, A. K. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27135937 · Cited by 1
“Several major pathways responsible for DNA repair, such as homologous recombination (HR), nucleotide excision repair (NER), and base excision repair (BER), are all typically increased in tumors that show resistance to clinical chemotherapy [81,82].”
Kaczmarek, I., Mokra, K., & Michałowicz, J. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27146221 · Cited by 1
“These characteristics embrace: metabolic activation, induction of oxidative stress, inflammation, immunosuppressive influence, and the ability to transform cells, making them “immortal” [148,151].”
Valaei, A., Zahmatkesh, N., Aghaei, R., Maleki, M., Meskini, M., & Siadat, S. D. (2026) · New Microbes and New Infections · doi:10.1016/j.nmni.2026.101805 · Cited by 2
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“This relationship between FAM110A expression and DNA repair capacity could be pivotal for understanding therapeutic responses since chemotherapeutic agents often target these pathways [39].”
Oncofetal Biology: From Fundamental Mechanisms to Emerging Therapeutic Opportunities
Liu, Y., Niu, K., Kong, Q., & Gao, S. (2026) · MedComm – Oncology · doi:10.1002/mog2.70071
Microbiome-Driven Diagnostic and Therapeutic Strategies in Cancer
Dilawari, R., Sharma, A., Verma, J., Thakur, R., Das, D., & Priyadarshi, N. (2026) · Onco · doi:10.3390/onco6020021 · Cited by 1
“Additionally, host DNA repair pathways can be altered by the microbiota to improve the efficacy of chemotherapy-induced damage in cancer cells [70].”
Sandhya, S., Singh, M., Jana, B. K., Talukdar, J., Baishya, D., Gogoi, G., Das, B., & Mazumder, B. (2026) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2026.1800786 · Cited by 1
“This resistance allows CSCs to survive therapy that kills the majority of tumor cells, leading to tumor relapse and metastasis (Dean et al., 2005; Phi et al., 2018; Li et al., 2020a; Begicevic and Falasca, 2017; Li and Bhatia, 2011).”
Kativa, M., Balupillai, A., Jayakumar, T., & Sheu, J. (2026) · Cell Biochemistry and Biophysics · doi:10.1007/s12013-026-02055-7 · Cited by 1
“Numerous scientific studies have documented that base excision repair (BER) proteins, such as FEN-1, APE1, PARP-1, and PCNA, otherwise known as DNA replication proteins, are highly expressed and contribute to the acquisi - tion of drug resistance in BC [49, 50 ].”
Bielesch, S., Vogel, I., Nokodian, S., Moeller, J., Blechschmidt, A., Hecht, V., Kuentzel, V., Thiedig, K., Schwab, M., Schilling, O., et al. (2026) · Molecular Oncology · doi:10.1002/1878-0261.70227 · Cited by 1
“…mechanisms fostering the tolerability of chemotherapy comprise (1) cytoskeletal remodelling resulting in a reinforced cytoskeletal framework [47], (2) EMP [48], (3) induction of survival pathways to overcome DNA damage [49], and (4) stem cell-like features promoting relapse after treatment [50].”
Guedes, A. R., Martins‐Gomes, C., Cunha, R., Silva, A. M., & Gaivão, I. (2026) · Mutation Research/Genetic Toxicology and Environmental Mutagenesis · doi:10.1016/j.mrgentox.2026.503923 · Cited by 1
The mechanism and research progress of the protective effects of plant polysaccharides on DNA damage
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Tsoi, H., So, Z.-Q., Man, E., You, C., Cheung, K. H.-L., Tse, Y.-S., Chan, W.-L., & Khoo, U. (2025) · Cells · doi:10.3390/cells14171341 · Cited by 1
“Similarly, in breast cancer, AR signaling may modulate DNA repair, particularly in response to DNA-damaging agents like DOX, which induces lethal double-strand breaks (DSBs) if unrepaired [18,19].”
Arefnezhd, R., Chahardehi, A. M., Asadi, A., Shadravan, M. M., Shariati, A., Rezaee, A., Radmanesh, M., Nazarian, M., Helfi, M., Meigoli, M. S. S., et al. (2025) · Brain Tumor Pathology · doi:10.1007/s10014-025-00501-7 · Cited by 1
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“It is important for regulating checkpoints properly and activation of DNA repair mechanism [6, 11, 12] .”
Laithy, Y. E., de Oliveira, W. A. A., Pabba, A., Qualizza, A., Richard, F., Athanasouli, P., Luci, C., Wispelaere, W. D., Mourão, L., Hamer, S., et al. (2024) · bioRxiv · doi:10.1101/2024.03.08.584051 · Cited by 1
“Conversely, Hallmarks associated with cell cycle regulation, such as G2M checkpoint, DNA Repair, MYC targets, and E2F targets were significantly downregulated in DOC-and CAR-treatment 31,32 (Fig.”
BackgroundSahay, O., Barik, G. K., Dey, S., Islam, S., Paul, D., Bhavsar, P. P., Nath, S., Rapole, S., & Santra, M. (2024) · bioRxiv · doi:10.1101/2024.06.03.596644 · Cited by 1
Profiling DNA damage in 3D Histology Samples
Peñas, K. E. D., Haeusler, R., Feng, S., Magidson, V., Dmitrieva, M., Wink, D., Lockett, S. J., Kinders, R., & Rittscher, J. (2022) · MOVI@MICCAI · doi:10.1007/978-3-031-16961-8_9 · Cited by 1
“Inhibiting such pathways and specific targeting of tumor cells can therefore enhance the anticancer effect of DNA damage-based therapy [17].”
Unblinding the watchmaker: cancer treatment and drug design in the face of evolutionary pressure
Konig, S., Strobel, H., Grunert, M., Łyszkiewicz, M., Brühl, O., Karpel‐Massler, G., Ziętara, N., Ferla-Brühl, K. L., Siegelin, M. D., Debatin, K., et al. (2022) · Expert Opinion on Drug Discovery · doi:10.1080/17460441.2022.2114454 · Cited by 1
“by upregulation of multidrug resistance pumps [18], adapt DNA repair mechanisms [17], or tolerate the damage, e.”
BackgroundHarrison, V. C., Khan, S. F., Damerell, V., Bleloch, J., ArulJothi, K. N., Sinkala, M., Lennard, K. S., Mulder, N., Calder, B., Blackburn, J. M., et al. (2022) · In Vitro Cellular & Developmental Biology - Animal · doi:10.1007/s11626-022-00714-6 · Cited by 1
“These results are important because one mechanism by which cancer cells confer drug resistance is the activation of DNA repair pathways which leads to cell survival, increased mutagenic lesions, and potentially the development of secondary tumors (Li et al. 2021).”
BackgroundAlao, J. P. (2026) · Applied Sciences · doi:10.3390/app162110611
Therapy resistance-related ncRNAs in cervical cancer: biomarkers and therapeutic targets
Liu, L., Zhang, L., & Ma, Z. (2026) · DARU Journal of Pharmaceutical Sciences · doi:10.1007/s40199-026-00660-8
“A central mechanism of therapy resistance involves dysregulation of the DNA damage response and repair machinery, which determines how CC cells respond to genotoxic stress induced by radiotherapy and DNA-damaging drugs [ 17, 55, 56 ].”
Timing of DNA damage checkpoint adaptation predicts post-mitotic proliferative competence
Dondi, A., Calabrese, E., Visintin, C., Spreafico, S., & Visintin, R. (2026) · bioRxiv · doi:10.64898/2026.09.15.751746
Xu, R., Xiao, X., Yang, J., Wang, T., Yu, Y., & Zhang, H. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1918117
“DNA repair systems maintain genomic integrity and restrain malignant alterations and heterogeneity in tumors, but on the other hand they promote tumor cells survive after radiotherapy and chemotherapy (29).”
Self-citationBisht, A., Jaiswal, A., Singh, R. P., Dey, S., & Kulshreshtha, R. (2026) · Apoptosis · doi:10.1007/s10495-026-02423-x
“Although DNA repair pathways are essential for preserving genomic stability and preventing tumour formation, their abnormal regulation can promote cancer initiation, resistance and progression [84, 85].”
Natural product derived phytochemicals as modulators of cancer stemness and drug resistance
Qazi, A. K., Parray, M. O., & Syed, S. H. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1940814
Canbek, S., Karaağaç, M., Ermiş, A., Türkan, Ş., Topal, C., Ilhan, N., Yalçınkaya, C., & Ezberci, F. (2026) · Molecular Biology Reports · doi:10.1007/s11033-026-12640-x
“The pathways have an influence on repairing damaged DNA, thus aiding to prevent the development and progression of cancer [ 4 ].”
RAD51 stabilizes neutrophil extracellular traps to compartmentalize inflammation
Tsansizi, L. I., Guan, S. Y., Aramburu, I. V., Punatar, R. S., Williams, T. J., Qiao, Y. E., Reed, A. K., Armstrong-James, D. P. H., West, S. C., & Papayannopoulos, V. (2026) · Science · doi:10.1126/science.aed9286
“DNA repair pathway inhibitors are used in the treatment of many cancers to promote genomic instability in tumours and boost antigen presentation (49, 50).”
Garg, P., & Singhal, S. S. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1904492
“Understanding these resistance mechanisms is essential for optimizing ADC design, improving biomarker-guided patient selection, and developing effective combination therapeutic strategies (21).”
Chakraborty, S., Shenoy, P. S., Nath, S., Panda, T. R., Bhat, A., Sakpal, A., Mehrotra, M., Singh, P., Patra, M., & Ray, P. (2026) · Medical Oncology · doi:10.1007/s12032-026-03348-w
Maćkowiak, B., Ostrowska, K., Kozikowska, J., Kulcenty, K., Golusiński, W., & Suchorska, W. (2026) · Journal of Cancer Research and Clinical Oncology · doi:10.1007/s00432-026-06563-0
“(Tor-govnick and Schumacher 2015), treatment sensitivity and resistance (Li et al. 2021), and post-treatment regeneration processes (Chen et al. 2024).”
Dissecting cancer in a non-mammalian model: genomic insights from lemon frost geckos
Hastings, B. T., Gamble, T., Ossiboff, R., Gazziero, V., Caravagna, G., Glaberman, S., & Chiari, Y. (2026) · BMC Biology · doi:10.1186/s12915-026-02661-0
“Fur - thermore, the detected copy-number LOH alterations may contribute to the early establishment and persistence of tumors, particularly through effects on DNA repair and apoptosis pathways [96].”
Strategies to Improve Sensitivity to Radiotherapy in Pediatric Solid Tumors
Shaikh, M. G., Brown, M. L., Aye, J. M., & Beierle, E. A. (2026) · Cancers · doi:10.3390/cancers18132103 · Cited by 1
“If the DNA damage is too extensive or repair mechanisms fail, cells will not replicate properly, leading to mitotic catastrophe, senescence, or apoptosis [25].”
Targeting mitochondria as a potential therapeutic strategy against radioresistance in cancer
Nazam, N., Sadiya, S., Khan, S., Misra, A., Sureka, N., Panwar, K., Sahani, N., & Zaheer, S. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1849057
Therapeutic targeting of DNA repair pathway dysregulation in aging, cancer, and neurodegeneration
Kumar, V., Kashif, M., Singh, V., Rawat, R. S., Khan, A., Sarkar, G. C., & Majood, M. (2026) · Expert Opinion on Therapeutic Targets · doi:10.1080/14728222.2026.2683686
Metadata
- Authors
- Li, L.-Y., Guan, Y.-D., Chen, X.-S., Yang, J.-M., & Cheng, Y.
- Affiliations
- Central South University (CN)
- Corresponding author
- Cheng, Yan
- ORCID
- Cheng, Yan
- Venue
- Frontiers in Pharmacology
- Publisher
- Frontiers Media SA
- Published
- 2021-02-08
- Volume
- 11
- Pages
- 629266-629266
- ISSN
- 1663-9812 (ISSN-L)
- PMC
- PMC7898236
- OpenAlex
- W3127551105
- Cited by
- 383
- References
- 140
- Citations by year
- 2026: 40 · 2025: 81 · 2024: 86 · 2023: 93 · 2022: 69 · 2021: 14
- FWCI
- 7.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Pharmacology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UKnowledge (University of Kentucky) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Natural Science Foundation of China (81422051 81472593 31401208)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › DNA Repair Mechanisms
- Health Sciences › Medicine › Oncology › PARP inhibition in cancer therapy
- Health Sciences › Medicine › Oncology › Cancer-related Molecular Pathways
- Keywords
- DNA repair pathways, DNA damage response, cancer therapy, chemoresistance, ionizing radiation, DNA-damaging agents, DNA repair inhibitors, mitochondrial DNA repair, tumor sensitivity
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