Nevertheless, cancer cells might target other adaptation mechanisms to escape chemotherapy; for example, in breast cancer, exosome-derived miRNA-9-5p, miRNA-195-5p and miRNA-203a-3p trigger the expression of stemness-associated genes, including Notch1, SRY-box transcription factor 9 (SOX9), SOX2, NANOG and octamer-binding transcription factor 4 (OCT4), leading to a cancer stem-like cell phenotype [173]. The gene discussed is SOX9; the disease is breast carcinoma.