Department of Hematology, Cambridge Institute for Medical Research and Addenbrookes Hospital, University of Cambridge, Hills Road, Cambridge CB2 0XY, UK; Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, Cambridge, UK.
Department of Hematology, Cambridge Institute for Medical Research and Addenbrookes Hospital, University of Cambridge, Hills Road, Cambridge CB2 0XY, UK; Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, Cambridge, UK.
Semin Cancer Biol. 2018 Aug;51:198-210. doi: 10.1016/j.semcancer.2017.07.005. Epub 2017 Aug 4.
Over the last decade transcriptional dysregulation and altered epigenetic programs have emerged as a hallmark in the majority of hematological cancers. Several epigenetic regulators are recurrently mutated in many hematological malignancies. In addition, in those cases that lack epigenetic mutations, altered function of epigenetic regulators has been shown to play a central role in the pathobiology of many hematological neoplasms, through mechanisms that are becoming increasingly understood. This, in turn, has led to the development of small molecule inhibitors of dysregulated epigenetic pathways as novel targeted therapies for hematological malignancies. In this review, we will present the most recent advances in our understanding of the role played by dysregulated epigenetic programs in the development and maintenance of hematological neoplasms. We will describe novel therapeutics targeting altered epigenetic programs and outline their mode of action. We will then discuss their use in specific conditions, identify potential limitations and putative toxicities while also providing an update on their current clinical development. Finally, we will highlight the opportunities presented by epigenetically targeted therapies in hematological malignancies and introduce the challenges that need to be tackled by both the research and clinical communities to best translate these novel therapies into clinical practice and to improve patient outcomes.
在过去的十年中,转录失调和表观遗传程序改变已成为大多数血液系统癌症的主要特征。许多血液系统恶性肿瘤中经常发生几种表观遗传调节剂的突变。此外,在那些缺乏表观遗传突变的情况下,已经表明表观遗传调节剂的功能改变通过越来越被理解的机制在许多血液系统肿瘤的病理生物学中发挥核心作用。这反过来又导致了针对血液系统恶性肿瘤的失调表观遗传途径的小分子抑制剂的开发作为新型靶向治疗。在这篇综述中,我们将介绍我们对失调表观遗传程序在血液系统肿瘤的发生和维持中所起作用的最新认识。我们将描述针对改变的表观遗传程序的新型治疗方法,并概述其作用模式。然后,我们将讨论它们在特定情况下的使用,确定潜在的局限性和潜在的毒性,同时更新它们目前的临床开发情况。最后,我们将强调血液系统恶性肿瘤中针对表观遗传的治疗方法所带来的机遇,并介绍研究和临床社区需要解决的挑战,以将这些新型治疗方法最佳地转化为临床实践并改善患者的预后。