FIGURE 9:

Model. After treatments that perturb cell cycle progression, a fraction of the cells escape apoptosis and instead enter the alternative cell cycle state of endoreplication (endocycle/endomitosis). Switching to endoreplication may provide a mechanism for therapy resistance. On discontinuation of the perturbation, many cells die, but a fraction of these polyploid cells resume mitotic divisions, which are highly error-prone, contributing to tumor heterogeneity and leading to cancer relapse.