Histone deacetylase (HDAC) inhibitors are emergent cancer drugs. HR23B is a candidate cancer biomarker identified in a genome-wide loss-of-function screen which influences sensitivity to HDAC inhibitors. Because HDAC inhibitors have found clinical utility in cutaneous T-cell lymphoma (CTCL), we evaluated the role of HR23B in CTCL cells. Our results show that HR23B governs the sensitivity of CTCL cells to HDAC inhibitors. Furthermore, proteasome activity is deregulated in HDAC inhibitor-treated CTCL cells through a mechanism dependent upon HR23B, and HDAC inhibitors sensitize CTCL cells to the effects of proteasome inhibitors. The predictive power of HR23B for clinical response to HDAC inhibitors was investigated through an analysis of a unique collection of CTCL biopsies taken from a phase II clinical trial, where there was a frequent coincidence between HR23B expression and clinical response to HDAC inhibitor. Our study supports the personalized medicine approach for treating cancer and the increasing drive to translate laboratory-based findings into clinical utility.cancer | histone deacetylase inhibitor | biomarker | proteasome | clinical trial I t is widely recognized that one of the most significant hurdles to developing new and efficacious cancer drugs is the absence of proven strategies that enable responsive tumors to be identified and treated with the most effective drug. Predictive biomarkers that inform on the clinical response to cancer therapies will not only assist in planning focused and hypothesis-driven clinical development programs but, once approved, provide a companion biomarker that enables patients to be stratified and aligned with an appropriate therapeutic regime (1).Aberrant epigenetic control is an early event in the onset of tumor progression, and there have been intense efforts to develop drugs that modulate epigenesis in cancer (2). One of the most promising approaches has been seen in the development of inhibitors of histone deacetylase (HDAC). HDAC is a family of enzymes that regulate the acetylation level of chromatin, together with a variety of nonhistone proteins (3). Proteins that are involved with tumor progression, including the cell cycle, apoptosis, angiogenesis, and cell invasion, are influenced by acetylation (4).HDAC inhibitors are potent antiproliferative agents in cellbased studies, where they exhibit striking effects on tumor cell proliferation (5-7). Consequently, there has been great interest in developing HDAC inhibitors as new anticancer agents, and an extensive number of clinical trials are underway in which HDAC inhibitors either alone or in combination with other agents are being evaluated (8). To date, SAHA (also known as Vorinostat and Zolinza) and more recently romidepsin (also known as depsipeptide, FK228, and Istodax) are the only HDAC inhibitorbased therapies that have achieved regulatory approval, being marketed for the treatment of advanced and refractory cutaneous T-cell lymphoma (CTCL) (9-11) (http://istodax.com) . Other than CTCL, tumor types that ha...