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1. Undergraduate Medicine student, Faculdade de Medicina da Universidade de São Paulo. São Paulo, Brazil. ORCID: 0000-00025478-5283. Email: matheus.zjunqueira@fm.usp.br. 2. Professor of Oncology, Department of Radiology e Oncology, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo. São Paulo, Brazil. Advisor and chief of the Center for Translational Investigation in Oncology. ORCID: 0000-0003-0342-8726. Email: rchammas@usp.br. Address: Matheus Z. Junqueira. Rua Conselheiro Pedro Luís, 300. Santana. São Paulo, SP, Brazil. CEP: 02020-050. ABSTRACT: Cancer is a highly prevalent and fatal disease, being one of the main causes of death in Brazil and in the world. In the last decades, a great advance has been reached in fight against cancer, with some translation in curability. However, these advances are still insufficient, and the prognosis of the cancer patient is usually unfavorable. Indeed, there are still many gaps in our knowledge about this complex and heterogeneous disease. Several treatments approaches against cancer are available to clinical practice and some others are being developed one of which is chemotherapy, both traditional and targeted therapy (TT), used above all as primary treatment for metastatic or secondary treatment in local or locally advanced disease. Several factors can act through many mechanisms to determine the failure of chemotherapy treatment. These factors are distributed across the various biological scales, from the molecular to the socioeconomic level, making the holistic view of treatment a great challenge and impairing the awareness of what can go wrong. The purpose of this paper is to be a comprehensive but not superficial picture of the many factors that influence the success of chemotherapy. In this way, the result of this work was this discussion on chemotherapy failure, were it was exposed recent advances, challenges to be overcome and new paths to be explored on this field.

Cancer chemotherapy failure: a synthetic view