Rb1 deficiency induces synthetic lethality with ATR and PKMYT1 co-inhibition in breast cancer

Targeting cell cycle checkpoints has emerged as a promising strategy in cancer therapy, yet single-agent inhibitors often fail due to compensatory mechanisms. Here, we demonstrate that co-inhibition of ATR (RP-3500) and PKMYT1 (RP-6306) induces synthetic lethality in Rb1-deficient breast cancers by disrupting both S/G2 and G2/M checkpoints, resulting in replication stress, premature mitotic entry, and DNA damage accumulation. In vitro, Rb1-deficient breast cancer cell lines exhibited marked apoptosis and loss of clonogenic potential, whereas Rb1-proficient models remained largely resistant to combination treatment. Genetic manipulation of Rb1 confirmed this dependency: Rb1 knockdown sensitized resistant models, and overexpression conferred protection. In vivo, patient-derived xenograft (PDX) models recapitulated these findings. Rb1-deficient tumors underwent complete regression, while Rb1-proficient tumors showed limited response with RP-3500/RP-6306 treatment. Combination therapy was well tolerated in vivo, without significant toxicity or weight loss. Biomarker analysis revealed increased ?H2AX and reduced Ki67 staining exclusively in Rb1-deficient PDX models, underscoring the specificity of this response. Mechanistically, Rb1 loss impaired double-strand DNA repair by attenuating homologous recombination and non-homologous end joining, leading to replication fork collapse, chromosomal instability, and mitotic catastrophe. Proteogenomic analysis identified JNK/p38 stress response pathway activation as a key driver of apoptosis following ATR/PKMYT1 inhibition in Rb1-deficient cells. Clinically, analysis of stage IV breast cancer patient datasets revealed that Rb1-low tumors display reduced DNA repair pathway activity and are enriched in triple-negative and CDK4/6 inhibitor-resistant luminal breast cancers. These findings establish Rb1 loss as a functional biomarker for ATR/PKMYT1-targeted therapy, offering a precision treatment strategy for advanced breast cancers. Overall design: Breast cancer cell lines MDA-MB-231, BT-549, MCF-7, MCF-7 PalbociclibResistant (MCF7PR) were collect at either baseline (DMSO) or under treatment 30 nM RP6306 (MYTi), 10 nM RP3500 (ATRi) or in combination (COMB) for 48 hours and harvest for total RNA and RNA sequencing. Each group havs at least three biological replicates.