refractory
Summary
Describes a disease that fails to respond to standard treatments despite appropriate trials. In oncology, indicates initial non-response to chemotherapy (vs. relapsed = responds then recurs).
Detail
Refractory disease reflects inherent or acquired resistance mechanisms. In cancer: mutations altering drug targets, upregulated efflux pumps, enhanced DNA repair, or anti-apoptotic pathways. In autoimmune disease: failure of multiple DMARDs. In heart failure: inadequate response to standard therapy. Recognition of refractoriness prompts escalation to alternative therapies, investigational agents, or palliative approaches.
Sources
- First Aid for the USMLE Step 1
- Robbins Basic Pathology
- Harrison's Principles of Internal Medicine
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