Standard treatment against paediatric BRAF-V600E glioma promotes senescence and sensitizes tumours to BCL-xL inhibition

Background Chemo-, radio-, and targeted therapies can induce senescence in tumour cells, a process called therapy-induced senescence (TIS), which can be exploited therapeutically using compounds that kill senescent cells (senolytics). Children with BRAF-V600E activated brain tumours are commonly treated with Dabrafenib, Trametinib or Vinblastine (alone or in combination) with good responses. However, a subset of patients experiences tumour regrowth upon treatment withdrawal. Here, we explore the role of TIS and senolytic therapies in preclinical models of paediatric BRAF-V600E driven brain tumours. Methods Human BT-40 tumour cells derived from pleomorphic xanthoastrocytoma are used in vitro or in vivo orthotopically transplanted into mice and treated with either Dabrafenib, Trametinib or Vinblastine. Senescence is assessed by immunostaining and RNA sequencing. Sensitivity to senolytics is determined in vitro in dose response assays and in vivo. Results Trametinib treatment induces a senescent phenotype in BT-40 cells in vivo with activation of a senescence-associated secretory phenotype (SASP) and expansion of IBA-1 microglia. Senescence is induced in BT-40 cells in vitro when treated not only with Trametinib, but also with Dabrafenib and Vinblastine. In vitro testing identifies Navitoclax as a potent senolytic against BT-40 senescent cells, mostly through inhibition of the anti-apoptotic protein BCL-xL. In BT-40 tumour bearing mice, combination of Trametinib and Navitoclax causes the ablation of senescent BT-40 cells with significant reduction in tumour regrowth after treatment withdrawal and increased mouse survival. Conclusions This study shows that Navitoclax enhances the anti-tumour efficacy of Trametinib and limits tumour regrowth following treatment withdrawal. Key Points Trametinib, Dabrafenib and Vinblastine induce senescence in BT-40 cells in vitro Senescent BT-40 cells are sensitive to BCL-xL inhibition Combination of Trametinib and Navitoclax reduces rebound tumour growth in vivo Importance of the Study Children with BRAF-V600E activated glioma are frequently treated with Dabrafenib, Trametinib or Vinblastine with good responses. However, a subset of patients shows tumour regrowth when the treatment is stopped. To prevent this rebound growth, patients must continue treatment with potential aggravation in quality of life and risk of malignant progression. Our research demonstrates that these therapies induce BT-40 tumour cells to enter a non-proliferative state that shows features of cellular senescence. We identify that senescent tumour cells can be killed using Navitoclax, and potent inhibitor of the anti-apoptotic protein BCL-xL and a well-studied senolytic. We demonstrate that the combination of Trametinib and Navitoclax reduces tumour regrowth after treatment withdrawal. Our research provides a strong rationale supporting the combined use of senolytics with current conventional and targeted therapies against BRAF-V600E mutated brain tumours.