Epigenetic therapies for cancer

This 2015 commentary on human epigenetic combination therapy for cancer noted:

“Epigenetic therapy is progressively growing in importance as a class of therapies for cancer.

Currently seven drugs are approved by the US FDA for the treatment of a variety of cancers, and target two major epigenetic systems..drugs that inhibit DNA methylation and those drugs that inhibit histone deacetylation.

However, conclusive evidence that these drugs function via an epigenetic mechanism does not exist.”

The authors ended the commentary with a nuanced point:

“The rate of complete response (eradication of the disease and normalization of the bone marrow) was higher with intensive chemotherapy, but the clinical outcome was better with low-dose chronic azacitidine [a DNA methyltransferase inhibitor] treatment.

Perhaps contrasting a killing-the-cancer strategy for intensive chemotherapy versus a modification of the phenotype by epigenetic therapy.”

I can appreciate that cancer researchers wouldn’t provide definitive statements. I’d guess that it may be too late for people diagnosed with cancer to effect “a modification of the phenotype” with the few epigenetic therapies the FDA has currently approved.

I wonder what difficulties existed that caused the authors to state “conclusive evidence that these drugs function via an epigenetic mechanism does not exist.” Did animal studies demonstrate whether preventative actions were effective for “a modification of the phenotype” to a non-cancerous phenotype for the human cancers where epigenetic therapies weren’t curative?

See the Individual evolution page for a discussion about “How does a phenotype influence its own change?”

http://www.futuremedicine.com/doi/abs/10.2217/epi.15.94 “The failure of epigenetic combination therapy for cancer and what it might be telling us about DNA methylation inhibitors”

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