Resistance to Taxanes in Triple-Negative Breast Cancer Associates with the Dynamics of a CD49f+ Tumor-Initiating Population

Taxanes are a mainstay of treatment for breast cancer, but resistance often develops followed by metastatic disease and mortality. Aiming to reveal the mechanisms underlying taxane resistance, we used breast cancer patient-derived orthoxenografts (PDX). Mimicking clinical behavior, triple-negative breast tumors (TNBCs) from PDX models were more sensitive to docetaxel than luminal tumors, but they progressively acquired resistance upon continuous drug administration. Mechanistically, we found that a CD49f+ chemoresistant population with tumor-initiating ability is present in sensitive tumors and expands during the acquisition of drug resistance. In the absence of the drug, the resistant CD49f+ population shrinks and taxane sensitivity is restored. We describe a transcriptional signature of resistance, predictive of recurrent disease after chemotherapy in TNBC. Together, these findings identify a CD49f+ population enriched in tumor-initiating ability and chemoresistance properties and evidence a drug holiday effect on the acquired resistance to docetaxel in triple-negative breast cancer. [Display omitted] •PDX models mimic the clinical response to docetaxel in breast cancer patients•Sensitivity to docetaxel can be regained in metastatic resistant TNBC•A tumor-initiating CD49f chemoresistant population is present in TNBC•Docetaxel resistance associates with the expansion of a CD49f+ population in TNBC To study docetaxel resistance in breast cancer, González-Suárez and colleagues utilize multiple PDX models including sensitive-resistant tumor pairs. The characterization of the tumor-initiating CD49f+ chemoresistant population that expands after acquisition of docetaxel resistance reveals potential biomarkers and novel targets for the treatment of resistant metastatic TNBC disease.