In BRAF-mutant melanoma, the current standard of care involves a combination therapy of BRAF and MEK inhibitors (BRAFi/MEKi) which target components of the MAPK/ERK signalling pathway. However, success of targeted therapies in treating metastatic melanoma is hampered by both acquired and inherent drug resistance, mainly contributed by overactivation of the MAPK/ERK pathway. Recent pre-clinical studies from our lab demonstrated that co-inhibiting CDK4/6 and PRMT5, both downstream of the MAPK/ERK pathway, was an effective therapeutic strategy in BRAF-mutant melanoma. Hence, we hypothesised that BRAFi-resistant melanoma cells would also respond to the dual inhibition of CDK4/6 and PRMT5, considering CDK4/6 and PRMT5 lie downstream of the activating events that lead to BRAFi/MEKi-resistance. Dose-response assays, revealed that melanoma cells that have increased resistance to BRAFi remain sensitive to CDK4/6 inhibitors (CDK4/6i) and PRMT5 inhibitors (PRMT5i). More importantly, co-inhibiting CDK4/6 and PRMT5 suppressed cell proliferation in resistant cells. shRNA knockdown of p53 decreased sensitivity to combination CDK4/6 and PRMT5 inhibition; suggesting p53 plays a role in the robust response in p53WT cells to this novel therapy. Surprisingly, the combination was also very effective in p53 mutant cells. Overall, evidence from our studies support the functional cooperativity of CDK4/6i and PRMT5i as a combination therapy, which can exert effects in a p53-dependent or independent manner, thus serving as a potential treatment strategy for BRAF-mutant melanoma patients that either have primary resistance or acquired resistance to BRAFi/MEKi.
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