Introduction c-Myc is encoded by the founding member of the MYC family of oncogenic transcription factors that also includes MYCN and MYCL. Overexpression of one of these oncogenes is seen in most human cancers and represents the most frequently deregulated genetic event in cancer. The reason for the recurrent selection for Myc activation in cancer is its biologic activities, which include many of the hallmarks of cancer such as stimulation of cell proliferation, inhibition of anti-growth signals and differentiation, induction of angiogenesis and even immortalization. Paradoxically though, Myc also triggers apoptosis, 1,2 which is a cellular defense against cancer. For that reason, mutations in genes governing or executing apoptotic pathways are always accompanying Myc mutations in tumors. 3 The tumor suppressor p53 is crucial in the defense against activated Myc oncogenes and it can be activated in 2 major ways: one pathway involving the Arf tumor suppressor and one involving the upstream kinases of the DNA damage response (DDR), ATM/ATR and DNA-PK. How Myc induces Arf 4 is not completely understood, but when it does, Arf inhibits the E3 ubiquitin ligase Mdm2, which is a transcriptional target of p53 and acts as its negative regulator. 5 By inhibiting Mdm2, Arf causes p53 accumulation, resulting in the activation of genes downstream of p53, such as those encoding the cell-cycle inhibitor p21, DNA repair proteins, or proapoptotic proteins of the Bcl-2 family, like Noxa and Puma. 5 A similar scenario is the end result of Myc activating a DDR, where unscheduled Myc-induced replication causes strand breaks leading to activation of ATM, ATR or DNA-PK. 6 Downstream of these are the Chk1/2 kinases, which regulate the phosphorylation of cyclin: Cdk complexes to transiently arrest cells in the S and G2 phases of the cell cycle. They also phosphorylate p53, which disrupts the interaction with Mdm2, resulting in p53 activation and a more prolonged arrest. 7 Importantly, however, because high levels of Myc can repress p21 gene transcription, 8,9 the outcome of p53 activation by both the Arf and the DDR pathways, in the context of Myc overexpression, tips the balance toward apoptosis rather than cell-cycle inhibition. 8,10 This may explain why oncogene-induced senescence seen in many precancerous lesions is rarely seen in Myc-induced tumors, but may be triggered when Myc itself is inactivated. 11 Genetic studies in mice have shown that the pathways triggering p53 described above are essential for keeping Myc in check but they are not mutually exclusive. For instance, inactivation of Arf or Atm in Myc-transgenic mice that normally develop B-cell lymphoma (eg, E-Myc mice) results in a dramatic acceleration of disease, but inactivation of p53 is even more deleterious, suggesting that both Arf and DDR pathways are important. [12][13][14][15] Interestingly, analyses of B-cell lymphomas that develop in Myctransgenic mice and in the human disease Burkitt lymphoma (BL), where Myc is overexpressed in B lymphocytes because of translo...