Early overactivation of non-muscle myosin II during adaptation to combined BRAF and MEK inhibitors in dedifferentiating cutaneous melanomas

Cutaneous melanoma is a very aggressive type of skin cancer with remarkable phenotypic plasticity that contributes to adaptation and resistance to targeted therapies against the MAPK pathway. Previous research described that non-muscle myosin II (NMII) of the actomyosin cytoskeleton, which is essential for cell migration and metastasis, is overactivated in BRAF inhibitor-resistant melanomas. Since the combination of BRAF and MEK inhibitors (BMi) is the current standard of care, we investigated if and how NMII activity is regulated during adaptation to BMi. Here, we find that most dedifferentiating BMi-resistant melanomas overactivate NMII compared to their parental counterparts. NMII activity generally increases during the first 2 weeks of BMi treatment, and it is followed by elevated total NMII levels due partly to transcriptional modulation. Although ERK activity rebounds with similar kinetics, NMII overactivation is not prevented by ERK inhibition but by blockade of ROCK. In melanomas that hyperdifferentiate during adaptation to BMi, NMII activity is not increased upon BMi treatment due, in part, to MITF. We also find that co-targeting NMII along BMi in some melanomas reduces survival of drug-tolerant persister cells, which would delay the development of resistance. Therefore, our study identifies elevated NMII activity as a potential marker of adaptation to MAPK in some melanoma subpopulations, and also provide an approach to delay the emergence of resistance to MAPK-targeted therapy.