Epigenetics breaks into the clinical practice of cancer

In the early 1980s, the first changes in DNA related to a chemical modification called methylation were discovered, followed by the discovery, in the mid-1990s, of the first tumor suppressor genes inactivated by these DNA modifications. genetic material. The early 2000s saw the first use of these altered marks as a biomarker of cancer disease, as well as the first uses of drugs against them.

In parallel, the first chemical modifications were detected in proteins called histones, where DNA wraps around them like a pearl necklace. All this “decoration” of DNA and its regulatory proteins defines the field of epigenetics.

Now, Dr. Manel Esteller, director of the Josep Carreras Leukemia Research Institute, ICREA Research Professor and Professor of Genetics at the University of Barcelona, ​​and researcher Dr. Verónica Dávalos, have carried out an analysis of the impact of this type of of research in the clinical management of cancer patients. The analysis, titled “Cancer epigenetics in clinical practice”, has been published in the academic journal CA: A Cancer Journal for Clinicians. This magazine is also the organ of expression of the American Cancer Society (ACS).

“Epigenetics has gone from being a purely basic research discipline, focused on studying how gene expression is controlled, to a tool for improving early detection, predicting disease progression and becoming a target for new treatments” , comments Dr. Esteller, adding “one of the most outstanding aspects of its clinical translation is its use in liquid biopsy, as well as in the classification of tumor types. This serves, for example, to correctly diagnose the types of tumors brain, skeletal muscles, joints, bones or of unknown origin. But it is that in addition to this aspect, DNA methylation profiles are approved to determine the efficacy of treatments in brain tumors and other tumor pathologies ” .

Dr. Manel Esteller and Dr. Verónica Dávalos. (Photo: Josep Carreras Leukemia Research Institute)

Perhaps one of the most exciting aspects for the medical oncologist is the use of epigenetic drugs to treat cancer. There are currently nine drugs against various epigenetic marks (DNA methylation and histone methylation and acetylation) approved for clinical use in various types of leukemia, lymphoma and blood diseases, as well as soft tissue tumors. According to Esteller, “these treatments are usually very well tolerated by patients and rather than kill the tumor cell, what they cause is a stop in its growth, as if it were a tamed beast.”

Epigenetic drugs are a clinical reality that is already providing benefits for patients, but research continues and, currently, there is a new generation of epigenetic drugs in different phases of clinical trials that, alone or combined with immunotherapy, can represent the positive difference in many patients. (Source: Josep Carreras Leukemia Research Institute)