Table 2.

Drug resistance factors for cancer stem cell areas

Area	Factors	References
Intrinsic Properties of CSCs
Self-renewal and differentiation	Ability to maintain stem cell phenotype and generate differentiated cells	[107–109]
Altered metabolism	Metabolic adaptations that support survival and proliferation	[110, 111]
DNA repair mechanisms	Efficient DNA repair pathways	[112–114]
Drug efflux	Expression of efflux pumps (e.g., ABC transporters) that remove drugs from cells	[115–117]
Tumor Microenvironment
Hypoxia	Low oxygen conditions	[118, 119]
Immune suppression	Suppression of immune response	[110, 120]
Extracellular matrix	Physical and biochemical properties of the tumor microenvironment	[110, 121]
Therapeutic Interventions
Drug combinations	Synergistic or additive effects of multiple drugs	[122, 123]
Drug repurposing	Using existing drugs for new indications	[124–126]
Targeted therapies	Targeting specific molecular pathways involved in cancer development and progression	[127–129]

An overview of the main regions and variables influencing cancer stem cell resistance is given in this table. Depending on the type of cancer, the properties of the cancer stem cells, and the therapeutic approaches employed, several pathways may be involved