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Cyclin-dependent kinases 2, 4, and 6 (CDK2/4/6) are a group of serine/threonine protein kinases that play a fundamental role in regulating the mammalian cell cycle, specifically the transition from the G1 phase to the S phase [2, 5, 13]. CDK4 and CDK6 are typically activated by D-type cyclins in response to growth factors, where they initiate the phosphorylation of the retinoblastoma (Rb) protein [6, 10, 15]. CDK2 is subsequently activated by E-type cyclins to complete Rb phosphorylation, thereby releasing E2F transcription factors that trigger DNA synthesis [5, 6, 17]. Dysregulation of the CDK-Rb pathway is a hallmark of many cancers, leading to the uncontrolled proliferation of malignant cells [2, 4, 13]. While CDK4/6 inhibitors like palbociclib and ribociclib have transformed the treatment of hormone receptor-positive breast cancer, many patients eventually develop resistance [1, 3, 7]. This resistance is frequently mediated by the compensatory overactivation of CDK2, which allows the cell cycle to proceed independently of CDK4/6 [1, 4, 8, 18]. Consequently, next-generation inhibitors targeting CDK2, CDK4, and CDK6 simultaneously, such as PF-06873600, are being developed to overcome this resistance and improve clinical outcomes [1, 16, 18]. These drugs work by inducing cell cycle arrest and senescence in tumor cells, though they are associated with side effects such as neutropenia and gastrointestinal distress [1, 14].
Inhibition of CDK2, CDK4, and CDK6 prevents the phosphorylation of the retinoblastoma (Rb) protein, thereby blocking the release of E2F transcription factors and arresting the cell cycle at the G1/S transition [1, 10, 12, 14]. This leads to the induction of cytostasis, senescence, and apoptosis in sensitive tumor cells [14, 15].
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