[HTML][HTML] TWIST1 upregulation is a potential target for reversing resistance to the CDK4/6 inhibitor in metastatic luminal breast cancer cells

N Cordani, L Mologni, R Piazza, P Tettamanti… - International Journal of …, 2023 - mdpi.com
N Cordani, L Mologni, R Piazza, P Tettamanti, V Cogliati, M Mauri, M Villa, F Malighetti…
International Journal of Molecular Sciences, 2023mdpi.com
Cyclin-dependent kinase (CDK) 4/6 inhibitors have significantly improved progression-free
survival in hormone-receptor-positive (HR+), human-epidermal-growth-factor-receptor-type-
2-negative (HER2−) metastatic luminal breast cancer (mLBC). Several studies have shown
that in patients with endocrine-sensitive or endocrine-resistant LBC, the addition of CDK4/6
inhibitors to endocrine therapy significantly prolongs progression-free survival. However, the
percentage of patients who are unresponsive or refractory to these therapies is as high as …
Cyclin-dependent kinase (CDK) 4/6 inhibitors have significantly improved progression-free survival in hormone-receptor-positive (HR+), human-epidermal-growth-factor-receptor-type-2-negative (HER2−) metastatic luminal breast cancer (mLBC). Several studies have shown that in patients with endocrine-sensitive or endocrine-resistant LBC, the addition of CDK4/6 inhibitors to endocrine therapy significantly prolongs progression-free survival. However, the percentage of patients who are unresponsive or refractory to these therapies is as high as 40%, and no reliable and reproducible biomarkers have been validated to select a priori responders or refractory patients. The selection of mutant clones in the target oncoprotein is the main cause of resistance. Other mechanisms such as oncogene amplification/overexpression or mutations in other pathways have been described in several models. In this study, we focused on palbociclib, a selective CDK4/6 inhibitor. We generated a human MCF-7 luminal breast cancer cell line that was able to survive and proliferate at different concentrations of palbociclib and also showed cross-resistance to abemaciclib. The resistant cell line was characterized via RNA sequencing and was found to strongly activate the epithelial-to-mesenchymal transition. Among the top deregulated genes, we found a dramatic downregulation of the CDK4 inhibitor CDKN2B and an upregulation of the TWIST1 transcription factor. TWIST1 was further validated as a target for the reversal of palbociclib resistance. This study provides new relevant information about the mechanisms of resistance to CDK4/6 inhibitors and suggests potential new markers for patients’ follow-up care during treatment.
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