Circular RNAs: key regulators of paclitaxel sensitivity and resistance in cancer.

Paclitaxel remains a cornerstone of cancer therapy, yet resistance significantly limits its clinical efficacy. Emerging evidence implicates circular RNAs (circRNAs) as key regulators of paclitaxel resistance, offering potential biomarkers and therapeutic targets. This review synthesizes current knowledge on circRNA-mediated resistance mechanisms, categorizing their roles as promoters or suppressors of chemoresistance. We highlight two major pathways-miRNA sponging and protein interactions-through which circRNAs alter drug sensitivity. Moreover, we focus on enhancement of epithelial-mesenchymal transition and modulation of autophagy as two significant downstream pathways influenced by the established primary mechanisms. Notably, our analysis reveals context-dependent dualities, where certain circRNAs exert opposing effects in different cancers, underscoring the need for tissue-specific therapeutic strategies. Furthermore, we identify critical gaps in understanding circRNA regulatory networks and their clinical translatability. By evaluating circRNA signatures associated with paclitaxel response, this review proposes a framework for biomarker development and combination therapies to circumvent resistance. Our findings emphasize the urgency of functional studies and standardized profiling methods to harness circRNAs for personalized oncology.