Abstract BACKGROUND Bromodomain inhibitors (BETi) have emerged as a potential treatment option for children with medulloblastoma, where hyperactivation of gene transcription by the MYC and MYCN transcription factors may lead to a transcriptional dependency. Yet, drug resistance limits the utility of these agents when employed as a monotherapy. We therefore sought to identify mechanisms of BETi resistance that inform rational development of multimodal therapy options. METHODS We used CRISPR screening of D458 medulloblastoma cells that have acquired resistance to the JQ1 inhibitor. We subsequently used small molecule inhibition and knockdown experiments to validate Menin as a target. Finally, we used RNAseq, ribosome profiling, and mass spectrometry to characterize transcriptional and post-transcriptional changes in D458 cells compared to D458 with JQ1 resistance. RESULTS In the setting of BETi resistance, we observed dependency on key transcriptional actors, such as MLL (KMT2A) and the Mediator complex, which we are now validating in mini-pool experiments. We further characterized aberrant MLL complex function through knockdown, small molecule inhibition, and RNA-sequencing of Menin, a critical MLL cofactor. Next, we were surprised to observe ribosome and proteosome genes as CRISPR dependencies in our initial screening of BETi-resistant cells, suggesting post-transcriptional regulation. Indeed, MYC, whose transcription is potently blocked by BETi, remained robust at the protein level in BETi resistance. We therefore performed integrated transcriptional, translational, and proteomic profiling to characterize gene regulation in BETi-resistance. We found that the BETi-resistant state leads to an “uncoupling” of transcriptional and post-transcriptional regulation for a subset of genes, leading us to test small molecule inhibitors of post-transcriptional processes in BETi-resistant medulloblastoma. CONCLUSIONS Taken together, our data inform an integrated model of BETi resistance based on both transcriptional and post-transcriptional mechanisms, suggesting new therapeutic angles that may be effective in combination with BETi therapies.