26 1 Endocrine-Related N Portman et al. CDK4/6 inhibitor resistance in 26:1 R15–R30 Cancer breast cancer REVIEW Overcoming CDK4/6 inhibitor resistance in ER-positive breast cancer Neil Portman1,2, Sarah Alexandrou1,2, Emma Carson1,2, Shudong Wang3, Elgene Lim1,2 and C Elizabeth Caldon1,2 1The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, New South Wales, Australia 2St. Vincent’s Clinical School, Faculty of Medicine, UNSW Sydney, New South Wales, Australia 3Centre for Drug Discovery and Development, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia Correspondence should be addressed to C E Caldon:
[email protected] Abstract Three inhibitors of CDK4/6 kinases were recently FDA approved for use in combination Key Words with endocrine therapy, and they significantly increase the progression-free survival of f CDK4/6 inhibitors patients with advanced estrogen receptor-positive (ER+) breast cancer in the first-line f estrogen receptor treatment setting. As the new standard of care in some countries, there is the clinical f breast cancer emergence of patients with breast cancer that is both CDK4/6 inhibitor and endocrine f endocrine therapy therapy resistant. The strategies to combat these cancers with resistance to multiple treatments are not yet defined and represent the next major clinical challenge in ER+ breast cancer. In this review, we discuss how the molecular landscape of endocrine therapy resistance may affect the response to CDK4/6 inhibitors, and how this intersects with biomarkers of intrinsic insensitivity. We identify the handful of pre-clinical models of acquired resistance to CDK4/6 inhibitors and discuss whether the molecular changes in these models are likely to be relevant or modified in the context of endocrine therapy resistance.