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ResearchIn-Press PreviewCell biologyOncology
Open Access |
10.1172/JCI199483
1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
Find articles by Awadia, S. in: PubMed | Google Scholar
1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
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1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
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1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
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1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
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1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
Find articles by Zimmerman, A. in: PubMed | Google Scholar
1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
Find articles by Mileski, M. in: PubMed | Google Scholar
1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
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1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
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1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
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1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
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1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
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1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
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1Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, United States of America
2Department of Radiology, The University of Michigan Medical School, Ann Arbor, United States of America
3Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States of America
4Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
5Department of Radiology and Imaging Sciences, Emory University and Georgia Institute of Technology, Atlanta, United States of America
6Department of Radiation Oncology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States of America
7Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, United States of America
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Rehemtulla, A.
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Published July 28, 2026 - More info
Resistance to CDK4/6 inhibitors (CDK4/6i) combined with endocrine therapy presents a major barrier to improving outcomes in ER+ breast cancer. We identified FADD phosphorylation at Ser194 (phospho-FADD) as a mediator of CDK4/6i resistance in the models examined. Phospho-FADD acted as a pseudosubstrate inhibitor of the APC/C-Cdh1 complex, promoting G1/S transition and bypassing the canonical CDK4/6-Rb-E2F pathway. This CDK4/6-independent pathway was associated with PI3K hyperactivation. Clinical relevance of this bypass pathway was supported by increased phospho-FADD and pAKT in 73% of paired patient biopsies at post-treatment recurrence, while the remaining cases exhibited high baseline phospho-FADD and pAKT with intrinsic non-response. Inhibition of FADD phosphorylation with the CK1α degrader DEG-77, or PI3K inhibition, restored CDK4/6i sensitivity in resistant cells. In CDK4/6i-refractory xenografts, CK1α degradation combined with CDK4/6i resulted in profound tumor regressions and increased progression-free survival compared with either single agent, including complete tumor regressions in 92% of tumors. These findings support CK1α-mediated FADD phosphorylation as a targetable resistance mechanism in a subset of CDK4/6i-resistant ER+/HER2– breast cancer.