AbstractOver the last decade, CDK4/6 inhibitors (palbociclib, ribociclib and abemaciclib) have emerged as promising anticancer drugs. Numerous studies have demonstrated that CDK4/6 inhibitors efficiently block the pRb-E2F pathway and induce cell cycle arrest in pRb-proficient cells. Based on these studies, the inhibitors have been approved by the FDA for treatment of advanced hormonal receptor (HR) positive breast cancers in combination with hormonal therapy. However, some evidence has recently shown unexpected effects of the inhibitors, promoting needs to understand more about the mechanism of inhibitors beyond pRb. Our study demonstrates here how palbociclib impairs the origin firing in the DNA replication process in pRb-deficient cell lines. Strikingly, despite the absence of pRb, cells treated with palbociclib synthesize less DNA without any induced cell cycle arrest. Furthermore, palbociclib treatment disturbs the temporal program of DNA replication and reduces the density of replication forks. Cells treated with palbociclib show a defect in the loading of proteins of the Pre-initiation complex (Pre-IC) on chromatin, indicating a reduced initiation of DNA replication. Our findings highlight hidden effects of palbociclib on the dynamics of DNA replication and on its cytotoxic consequences on cell viability in the absence of pRb. This study provides a potential therapeutic application of palbociclib to target genomic instability towards pRb deficient patients.Significance StatementPalbociclib is a promising anticancer drug for pRb-proficient cell, particularly for hormonal receptor positive breast cancer, that induces the cell cycle arrest. But what about pRb deficient cell lines ? Our results show that Palbociclib disturb the DNA replication process inducing a replicative stress, an increase of DNA damages and leading to a significant decrease in cell viability. Palbociclib impairs the DNA synthesis reducing the number of active origins with the decrease of availability of the pre-initiation complexes. We believe that the demonstration of this effect of palbociclib on pRb-deficient cells may be a new therapeutic entry point in combination with other treatments for these types of cancer. Replicative stress can be one of weaknesses of pRb defficient cancer cells.