Abstract To avoid cell death, cancer cells adapt to extreme conditions. Chaperone upregulation, modulation of the unfolded protein response (UPR), and induction of protein degradation pathways are critical for cancer cell survival and metastasis in some cancers. Thus, it is not surprising that the molecular chaperone Hsp70 is upregulated in many cancers. For example, increased Hsp70 abundance correlates with metastasis formation and poor prognosis in breast cancer patients. We previously demonstrated that inhibition of Hsp70, by treating cells with a specific inhibitor known as MAL3-101, induces rhabdomyosarcoma cancer cell death due to induction of a UPR-mediated apoptotic response (Sabinis et al., 2016). Moreover, by taking advantage of a MAL3-101-resistant cell line, we established that protein degradation pathways act as a compensatory mechanism in MAL3-101 resistant rhabdomyosarcoma cells. In particular, we found that autophagy inhibition re-sensitized resistant cells to Hsp70 inhibition, suggesting that autophagy is a key compensatory mechanism for Hsp70 inhibition. Autophagy was further induced by MAL3-101 treatment in these cells, as evidenced by both autophagy related gene mRNA and protein accumulation as well as by autophagic-like structures detected by electron microscopy (Sannino et al., 2018). These data highlight a pro-survival role for autophagy induction upon exposure to an Hsp70 inhibitor in cancer, and provide a link between Hsp70, proteasome activity, the UPR, and autophagy in rhabdomyosarcoma. We next asked if other cancers might be dependent on Hsp70 activity and investigated the benefit of combined treatment with autophagy and/or proteasome inhibitors together with MAL3-101 in breast cancer cells. Our recent studies suggest that diverse breast cancer cell lines are either sensitive or resistant to Hsp70 inhibition. MAL3-101 resistant breast cancer cells have higher autophagy levels compared to MAL3-101 sensitive lines. Moreover, autophagy is upregulated upon Hsp70 inhibition in resistant breast cancer cells, again highlighting the potential benefit of combined treatment with autophagy and Hsp70 inhibitors. Overall, our work positions autophagy as a critical compensatory mechanism when molecular chaperone function is overwhelmed and misfolded proteins accumulate in cancer cells. Further investigations will reveal the potential for Hsp70 inhibitors and the role of protein degradation pathways in vivo in breast cancer. Citation Format: Sara Sannino, Jeffrey L. Brodsky. Synergistic roles played by autophagy and Hsp70 in cancer cell survival [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1232.