The future of epigenetic therapy in solid tumours—lessons from the past

N Azad, CA Zahnow, CM Rudin… - Nature reviews Clinical …, 2013 - nature.com
Nature reviews Clinical oncology, 2013nature.com
The promise of targeting epigenetic abnormalities for cancer therapy has not been realized
for solid tumours, although increasing evidence is demonstrating its worth in haematological
malignancies. In fact, true clinical efficacy in haematopoietic-related neoplasms has only
become evident at low doses of epigenetic-targeting drugs (namely, inhibitors of histone
deacetylase and DNA methyltransferases). Describing data from preclinical studies and
early clinical trial results, we hypothesize that in using low-dose epigenetic-modulating …
Abstract
The promise of targeting epigenetic abnormalities for cancer therapy has not been realized for solid tumours, although increasing evidence is demonstrating its worth in haematological malignancies. In fact, true clinical efficacy in haematopoietic-related neoplasms has only become evident at low doses of epigenetic-targeting drugs (namely, inhibitors of histone deacetylase and DNA methyltransferases). Describing data from preclinical studies and early clinical trial results, we hypothesize that in using low-dose epigenetic-modulating agents, tumour cells can be reprogrammed, which overrides any immediate cytotoxic and off-target effect observed at high dose. We suggest that such optimization of drug dosing and scheduling of currently available agents could give these agents a prominent place in cancer management—when used alone or in combination with other therapies. If so, optimal use of these known agents might also pave the way for the introduction of other agents that target the epigenome.
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