Abstract 5537: How aging promotes immune mediated reactivation from metastatic melanoma dormancy

Abstract Disseminated cancer cells that escape the primary tumor can seed distal tissues but may take several years to grow into clinically detectable metastases, a phenomenon termed tumor dormancy. Despite its importance in metastasis and residual disease, few studies have been able to successfully model melanoma dormancy. We have previously shown that while tumors grow more slowly in aged mouse skin, they form more lung metastases in aged mice compared to young mice. We queried whether the lung microenvironment undergoes age-related changes that establish a permissive niche for metastatic outgrowth. We identified that Wnt5A and AXL are not only required for efficient dissemination away from the primary tumor but also activate dormancy of melanoma cells within the lung. The young lung microenvironment maintains melanoma cells in a dormant state; however, age-associated reprograming of lung fibroblasts increases secretion of the soluble Wnt antagonist sFRP1, which inhibits both Wnt5A and AXL to enable reactivation from dormancy and the formation of larger metastatic colonies in the aged lung. We found that downregulation of AXL in melanoma cells leads to an increase in the related TAM family receptor MERTK, which promotes a proliferative melanoma phenotype and enables reactivation from dormancy. We have now found that both the aged-pre and post metastatic niche regulate immune cells in the lung to create a permissive niche for reactivation of metastatic melanoma. NK cells are significantly decreased in the healthy lungs of aged mice, are significantly less active, and have increased exhaustion markers. NK cell infiltration remains low in early and late-stage metastasis in aged mice. Depletion of NK cells in young mice is sufficient to induce reactivation from dormancy. Further, MERTK induced reactivation of melanoma cells results in paracrine secretion of its own ligand PROS1 to facilitate a growth permissive lung microenvironment. Melanoma-secreted PROS1 increases infiltration of PMN-MDSCs and decreases macrophage infiltration to maintain an immunosuppressive lung niche for efficient outgrowth. Selective inhibition of PMN-MDSCs using a TRIAL-R2 agonistic antibody significantly decreases metastatic outgrowth and promotes smaller, non-proliferative dormant colonies. Our findings indicate a significant role that aging plays in altering NK-cell infiltration and function to create a growth permissive pre-metastatic niche and how reactivation from dormancy can further contribute to create an immunosuppressive microenvironment for efficient outgrowth via PROS1 induced infiltration of PMN-MDSCs. Importantly, the clear differences found in our young and aged mouse modelling systems for outgrowth in metastatic tissues necessitates the need for age-appropriate pre-clinical modelling for better patient and disease representation. Citation Format: Pulkit Datt, Jhon Passamonte, Christopher Price, Daniel Zabransky, Yash Chhabra, Ashani Weeraratna, Mitchell E. Fane. How aging promotes immune mediated reactivation from metastatic melanoma dormancy abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts) ; 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84 (6Suppl): Abstract nr 5537.