Drug efflux pumps (ABC transporters)
Molecular pumps on cancer cells that eject chemotherapy and ADC payloads before they can act.
ABCB1 (P-glycoprotein/MDR1), ABCG2 (BCRP), ABCC1 (MRP1). Substrates include taxanes, anthracyclines, MMAE, DXd, SN-38 (ABCG2). Upregulated in mesenchymal and stem-like states. Some newer payloads and radiation are efflux-independent. Pump inhibitors failed clinically due to toxicity.
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