Pub Date : 2025-01-03DOI: 10.1038/s41571-024-00982-z
Peter Sidaway
Axillary nodal status provides important information on the prognosis of women with invasive breast cancer. However, the required sentinel lymph node biopsy sampling procedure and the associated risks of surgical complications have raised questions regarding the necessity of this procedure in women undergoing breast-conserving surgery for early stage disease. Now, data from INSEMA, a prospective, randomized, non-inferiority trial, confirm that this procedure can safely be avoided.
A total of 5,154 women with node-negative (on ultrasonography) T1 or T2 breast cancer were randomly assigned (1:4) to breast-conserving surgery without, versus with, axillary surgery. Invasive-disease-free survival (iDFS) was the primary end point.
{"title":"Women with clinically node negative breast cancer can safely avoid axillary surgery","authors":"Peter Sidaway","doi":"10.1038/s41571-024-00982-z","DOIUrl":"https://doi.org/10.1038/s41571-024-00982-z","url":null,"abstract":"<p>Axillary nodal status provides important information on the prognosis of women with invasive breast cancer. However, the required sentinel lymph node biopsy sampling procedure and the associated risks of surgical complications have raised questions regarding the necessity of this procedure in women undergoing breast-conserving surgery for early stage disease. Now, data from INSEMA, a prospective, randomized, non-inferiority trial, confirm that this procedure can safely be avoided.</p><p>A total of 5,154 women with node-negative (on ultrasonography) T1 or T2 breast cancer were randomly assigned (1:4) to breast-conserving surgery without, versus with, axillary surgery. Invasive-disease-free survival (iDFS) was the primary end point.</p>","PeriodicalId":19079,"journal":{"name":"Nature Reviews Clinical Oncology","volume":"27 1","pages":""},"PeriodicalIF":78.8,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-02DOI: 10.1038/s41571-024-00983-y
David Killock
Various endocrine therapies and CDK4/6 inhibitors have improved the treatment of ER+HER2−breast cancer, although resistance remains common and often involves ESR1 (encoding ERα) mutations. Now, data from the phase III EMBER-3 trial demonstrate that the next-generation, brain-penetrant, oral selective ER degrader imlunestrant delays disease progression in previously treated patients with ESR1 mutations, and regardless of ESR1 status when combined with abemaciclib.
In EMBER-3, patients with progression of ER+ HER2− breast cancer during or ≤1 year after completing (neo)adjuvant therapy with an aromatase inhibitor, or during first-line treatment for advanced-stage disease, were randomly assigned to receive imlunestrant (n = 331), standard endocrine therapy (exemestane or fulvestrant; n = 330), or imlunestrant–abemaciclib (n = 213). The majority of patients (59.8%) had also received a prior CDK4/6 inhibitor, most for advanced-stage disease. The primary end points were progression-free survival (PFS) with imlunestrant versus standard therapy among patients with ESR1 mutations and among all patients, and with imlunestrant–abemaciclib versus imlunestrant among all patients.
{"title":"Imlunestrant shows efficacy both with and without abemaciclib","authors":"David Killock","doi":"10.1038/s41571-024-00983-y","DOIUrl":"https://doi.org/10.1038/s41571-024-00983-y","url":null,"abstract":"<p>Various endocrine therapies and CDK4/6 inhibitors have improved the treatment of ER<sup>+</sup>HER2<sup>−</sup>breast cancer, although resistance remains common and often involves <i>ESR1</i> (encoding ERα) mutations. Now, data from the phase III EMBER-3 trial demonstrate that the next-generation, brain-penetrant, oral selective ER degrader imlunestrant delays disease progression in previously treated patients with <i>ESR1</i> mutations, and regardless of <i>ESR1</i> status when combined with abemaciclib.</p><p>In EMBER-3, patients with progression of ER<sup>+</sup> HER2<sup>−</sup> breast cancer during or ≤1 year after completing (neo)adjuvant therapy with an aromatase inhibitor, or during first-line treatment for advanced-stage disease, were randomly assigned to receive imlunestrant (<i>n</i> = 331), standard endocrine therapy (exemestane or fulvestrant; <i>n</i> = 330), or imlunestrant–abemaciclib (<i>n</i> = 213). The majority of patients (59.8%) had also received a prior CDK4/6 inhibitor, most for advanced-stage disease. The primary end points were progression-free survival (PFS) with imlunestrant versus standard therapy among patients with <i>ESR1</i> mutations and among all patients, and with imlunestrant–abemaciclib versus imlunestrant among all patients.</p>","PeriodicalId":19079,"journal":{"name":"Nature Reviews Clinical Oncology","volume":"5 1","pages":""},"PeriodicalIF":78.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-11DOI: 10.1038/s41571-024-00978-9
Peter Sidaway
{"title":"Ipilimumab plus nivolumab efficacious in patients with dMMR/MSI-H disease","authors":"Peter Sidaway","doi":"10.1038/s41571-024-00978-9","DOIUrl":"10.1038/s41571-024-00978-9","url":null,"abstract":"","PeriodicalId":19079,"journal":{"name":"Nature Reviews Clinical Oncology","volume":"22 2","pages":"79-79"},"PeriodicalIF":81.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142809629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-10DOI: 10.1038/s41571-024-00969-w
Maryann Zhao, Jonathan D. Schoenfeld, Ann Marie Egloff, Glenn J. Hanna, Robert I. Haddad, Douglas R. Adkins, Ravindra Uppaluri
Immune-checkpoint inhibitors (ICIs) are being tested as neoadjuvant therapies in various solid tumours, including in patients with head and neck squamous cell carcinoma (HNSCC), with promising results. Key findings thus far include that this approach is well-tolerated with favourable clinical outcomes including promising pathological response rates in initial studies. Pathological responses are likely to be increased by combining other agents with anti-PD-(L)1 antibodies. Comparisons of baseline biopsy samples with post-treatment surgical specimens have enabled correlative studies utilizing multiomic and immunogenomic methods. Data from these studies suggest that pretreatment intratumoural tissue-resident memory CD8+ T cells are key drivers of tumour regression and give rise to both local and systemic antitumour immune responses. Analyses of systemic responses have defined a PD-1+KLRG1− circulating CD8+ T cell subpopulation that is highly predictive of response, and revealed the interrelationships between intratumoural clones and circulating CD8+ T cells. Lastly, interrogation of T cell populations within lymph nodes is beginning to delineate the immune crosstalk between the primary tumour and tumour-draining lymph nodes and how this relationship might be disrupted with tumour infiltration of the latter. In this Review, we examine data from trials testing neoadjuvant ICIs in patients with HNSCC, focusing on human papillomavirus-unrelated disease, and highlight correlative immunogenomic findings from these trials. Neoadjuvant administration of immune-checkpoint inhibitors (ICIs) has substantially improved the outcomes in patients with various solid tumours, including those with head and neck cancer. However, not all patients derive benefit, indicating a need for biomarkers that enable accurate predictions of a response to these agents. In this Review the authors describe changes in both intratumour and circulating T cells in patients with locally advanced head and neck cancer receiving neoadjuvant ICIs, and consider the role of specific T cell subsets as biomarkers in this setting.
{"title":"T cell dynamics with neoadjuvant immunotherapy in head and neck cancer","authors":"Maryann Zhao, Jonathan D. Schoenfeld, Ann Marie Egloff, Glenn J. Hanna, Robert I. Haddad, Douglas R. Adkins, Ravindra Uppaluri","doi":"10.1038/s41571-024-00969-w","DOIUrl":"10.1038/s41571-024-00969-w","url":null,"abstract":"Immune-checkpoint inhibitors (ICIs) are being tested as neoadjuvant therapies in various solid tumours, including in patients with head and neck squamous cell carcinoma (HNSCC), with promising results. Key findings thus far include that this approach is well-tolerated with favourable clinical outcomes including promising pathological response rates in initial studies. Pathological responses are likely to be increased by combining other agents with anti-PD-(L)1 antibodies. Comparisons of baseline biopsy samples with post-treatment surgical specimens have enabled correlative studies utilizing multiomic and immunogenomic methods. Data from these studies suggest that pretreatment intratumoural tissue-resident memory CD8+ T cells are key drivers of tumour regression and give rise to both local and systemic antitumour immune responses. Analyses of systemic responses have defined a PD-1+KLRG1− circulating CD8+ T cell subpopulation that is highly predictive of response, and revealed the interrelationships between intratumoural clones and circulating CD8+ T cells. Lastly, interrogation of T cell populations within lymph nodes is beginning to delineate the immune crosstalk between the primary tumour and tumour-draining lymph nodes and how this relationship might be disrupted with tumour infiltration of the latter. In this Review, we examine data from trials testing neoadjuvant ICIs in patients with HNSCC, focusing on human papillomavirus-unrelated disease, and highlight correlative immunogenomic findings from these trials. Neoadjuvant administration of immune-checkpoint inhibitors (ICIs) has substantially improved the outcomes in patients with various solid tumours, including those with head and neck cancer. However, not all patients derive benefit, indicating a need for biomarkers that enable accurate predictions of a response to these agents. In this Review the authors describe changes in both intratumour and circulating T cells in patients with locally advanced head and neck cancer receiving neoadjuvant ICIs, and consider the role of specific T cell subsets as biomarkers in this setting.","PeriodicalId":19079,"journal":{"name":"Nature Reviews Clinical Oncology","volume":"22 2","pages":"83-94"},"PeriodicalIF":81.1,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-09DOI: 10.1038/s41571-024-00970-3
Ahmad Ozair, Hannah Wilding, Debarati Bhanja, Nicholas Mikolajewicz, Michael Glantz, Stuart A. Grossman, Arjun Sahgal, Emilie Le Rhun, Michael Weller, Tobias Weiss, Tracy T. Batchelor, Patrick Y. Wen, Daphne A. Haas-Kogan, Mustafa Khasraw, Roberta Rudà, Riccardo Soffietti, Philipp Vollmuth, Vivek Subbiah, Chetan Bettegowda, Lily C. Pham, Graeme F. Woodworth, Manmeet S. Ahluwalia, Alireza Mansouri
Leptomeningeal metastatic disease (LMD), encompassing entities of ‘meningeal carcinomatosis’, neoplastic meningitis’ and ‘leukaemic/lymphomatous meningitis’, arises secondary to the metastatic dissemination of cancer cells from extracranial and certain intracranial malignancies into the leptomeninges and cerebrospinal fluid. The clinical burden of LMD has been increasing secondary to more sensitive diagnostics, aggressive local therapies for discrete brain metastases, and improved management of extracranial disease with targeted and immunotherapeutic agents, resulting in improved survival. However, owing to drug delivery challenges and the unique microenvironment of LMD, novel therapies against systemic disease have not yet translated into improved outcomes for these patients. Underdiagnosis and misdiagnosis are common, response assessment remains challenging, and the prognosis associated with this disease of whole neuroaxis remains extremely poor. The dearth of effective therapies is further challenged by the difficulties in studying this dynamic disease state. In this Review, a multidisciplinary group of experts describe the emerging evidence and areas of active investigation in LMD and provide directed recommendations for future research. Drawing upon paradigm-changing advances in mechanistic science, computational approaches, and trial design, the authors discuss domain-specific and cross-disciplinary strategies for optimizing the clinical and translational research landscape for LMD. Advances in diagnostics, multi-agent intrathecal therapies, cell-based therapies, immunotherapies, proton craniospinal irradiation and ongoing clinical trials offer hope for improving outcomes for patients with LMD. Leptomeningeal metastatic disease (LMD) arises secondary to the metastatic dissemination of cancer cells into the leptomeninges and cerebrospinal fluid. Novel therapies against systemic disease have not yet translated into improved outcomes for patients with LMD, in whom median survival after diagnosis remains at 2–6 months. The authors of this Review, a multidisciplinary group of experts, describe the emerging evidence and areas of active investigation in LMD and provide directed recommendations for future research.
{"title":"Leptomeningeal metastatic disease: new frontiers and future directions","authors":"Ahmad Ozair, Hannah Wilding, Debarati Bhanja, Nicholas Mikolajewicz, Michael Glantz, Stuart A. Grossman, Arjun Sahgal, Emilie Le Rhun, Michael Weller, Tobias Weiss, Tracy T. Batchelor, Patrick Y. Wen, Daphne A. Haas-Kogan, Mustafa Khasraw, Roberta Rudà, Riccardo Soffietti, Philipp Vollmuth, Vivek Subbiah, Chetan Bettegowda, Lily C. Pham, Graeme F. Woodworth, Manmeet S. Ahluwalia, Alireza Mansouri","doi":"10.1038/s41571-024-00970-3","DOIUrl":"10.1038/s41571-024-00970-3","url":null,"abstract":"Leptomeningeal metastatic disease (LMD), encompassing entities of ‘meningeal carcinomatosis’, neoplastic meningitis’ and ‘leukaemic/lymphomatous meningitis’, arises secondary to the metastatic dissemination of cancer cells from extracranial and certain intracranial malignancies into the leptomeninges and cerebrospinal fluid. The clinical burden of LMD has been increasing secondary to more sensitive diagnostics, aggressive local therapies for discrete brain metastases, and improved management of extracranial disease with targeted and immunotherapeutic agents, resulting in improved survival. However, owing to drug delivery challenges and the unique microenvironment of LMD, novel therapies against systemic disease have not yet translated into improved outcomes for these patients. Underdiagnosis and misdiagnosis are common, response assessment remains challenging, and the prognosis associated with this disease of whole neuroaxis remains extremely poor. The dearth of effective therapies is further challenged by the difficulties in studying this dynamic disease state. In this Review, a multidisciplinary group of experts describe the emerging evidence and areas of active investigation in LMD and provide directed recommendations for future research. Drawing upon paradigm-changing advances in mechanistic science, computational approaches, and trial design, the authors discuss domain-specific and cross-disciplinary strategies for optimizing the clinical and translational research landscape for LMD. Advances in diagnostics, multi-agent intrathecal therapies, cell-based therapies, immunotherapies, proton craniospinal irradiation and ongoing clinical trials offer hope for improving outcomes for patients with LMD. Leptomeningeal metastatic disease (LMD) arises secondary to the metastatic dissemination of cancer cells into the leptomeninges and cerebrospinal fluid. Novel therapies against systemic disease have not yet translated into improved outcomes for patients with LMD, in whom median survival after diagnosis remains at 2–6 months. The authors of this Review, a multidisciplinary group of experts, describe the emerging evidence and areas of active investigation in LMD and provide directed recommendations for future research.","PeriodicalId":19079,"journal":{"name":"Nature Reviews Clinical Oncology","volume":"22 2","pages":"134-154"},"PeriodicalIF":81.1,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-03DOI: 10.1038/s41571-024-00966-z
Natalie Y. L. Ngoi, David Gallo, Carlos Torrado, Mirella Nardo, Daniel Durocher, Timothy A. Yap
Synthetic lethality is a genetic phenomenon whereby the simultaneous presence of two different genetic alterations impairs cellular viability. Importantly, targeting synthetic lethal interactions offers potential therapeutic strategies for cancers with alterations in pathways that might otherwise be considered undruggable. High-throughput screening methods based on modern CRISPR–Cas9 technologies have emerged and become crucial for identifying novel synthetic lethal interactions with the potential for translation into biologically rational cancer therapeutic strategies as well as associated predictive biomarkers of response capable of guiding patient selection. Spurred by the clinical success of PARP inhibitors in patients with BRCA-mutant cancers, novel agents targeting multiple synthetic lethal interactions within DNA damage response pathways are in clinical development, and rational strategies targeting synthetic lethal interactions spanning alterations in epigenetic, metabolic and proliferative pathways have also emerged and are in late preclinical and/or early clinical testing. In this Review, we provide a comprehensive overview of established and emerging technologies for synthetic lethal drug discovery and development and discuss promising therapeutic strategies targeting such interactions. The experience with PARP inhibitors provides evidence of the clinical utility of synthetic lethality, whereby the simultaneous presence of two specific alterations is required for antitumour activity. In this Review, the authors describe attempts to identify novel synthetic lethal interactions, including the role of emerging technologies in identifying new synthetic lethal relationships as well as novel agents that are currently being tested in clinical trials that might extend the clinical relevance of synthetic lethality beyond PARP inhibitors.
{"title":"Synthetic lethal strategies for the development of cancer therapeutics","authors":"Natalie Y. L. Ngoi, David Gallo, Carlos Torrado, Mirella Nardo, Daniel Durocher, Timothy A. Yap","doi":"10.1038/s41571-024-00966-z","DOIUrl":"10.1038/s41571-024-00966-z","url":null,"abstract":"Synthetic lethality is a genetic phenomenon whereby the simultaneous presence of two different genetic alterations impairs cellular viability. Importantly, targeting synthetic lethal interactions offers potential therapeutic strategies for cancers with alterations in pathways that might otherwise be considered undruggable. High-throughput screening methods based on modern CRISPR–Cas9 technologies have emerged and become crucial for identifying novel synthetic lethal interactions with the potential for translation into biologically rational cancer therapeutic strategies as well as associated predictive biomarkers of response capable of guiding patient selection. Spurred by the clinical success of PARP inhibitors in patients with BRCA-mutant cancers, novel agents targeting multiple synthetic lethal interactions within DNA damage response pathways are in clinical development, and rational strategies targeting synthetic lethal interactions spanning alterations in epigenetic, metabolic and proliferative pathways have also emerged and are in late preclinical and/or early clinical testing. In this Review, we provide a comprehensive overview of established and emerging technologies for synthetic lethal drug discovery and development and discuss promising therapeutic strategies targeting such interactions. The experience with PARP inhibitors provides evidence of the clinical utility of synthetic lethality, whereby the simultaneous presence of two specific alterations is required for antitumour activity. In this Review, the authors describe attempts to identify novel synthetic lethal interactions, including the role of emerging technologies in identifying new synthetic lethal relationships as well as novel agents that are currently being tested in clinical trials that might extend the clinical relevance of synthetic lethality beyond PARP inhibitors.","PeriodicalId":19079,"journal":{"name":"Nature Reviews Clinical Oncology","volume":"22 1","pages":"46-64"},"PeriodicalIF":81.1,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41571-024-00966-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142760331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-03DOI: 10.1038/s41571-024-00976-x
Tina Cascone, William N. William Jr.
As one of the first studies testing perioperative anti-PD-(L)1 antibodies in resectable non-small-cell lung cancer (NSCLC), NADIM now confirms, in its final report, impressive 5-year clinical outcomes and that a pCR following neoadjuvant therapy translates into improved long-term survival. These data support the development of novel, personalized treatments for locally advanced resectable NSCLC.
{"title":"Perioperative nivolumab results in favourable long-term outcomes in patients with locally advanced resectable non-small-cell lung cancer","authors":"Tina Cascone, William N. William Jr.","doi":"10.1038/s41571-024-00976-x","DOIUrl":"10.1038/s41571-024-00976-x","url":null,"abstract":"As one of the first studies testing perioperative anti-PD-(L)1 antibodies in resectable non-small-cell lung cancer (NSCLC), NADIM now confirms, in its final report, impressive 5-year clinical outcomes and that a pCR following neoadjuvant therapy translates into improved long-term survival. These data support the development of novel, personalized treatments for locally advanced resectable NSCLC.","PeriodicalId":19079,"journal":{"name":"Nature Reviews Clinical Oncology","volume":"22 2","pages":"81-82"},"PeriodicalIF":81.1,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142760484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-02DOI: 10.1038/s41571-024-00972-1
Seda S. Tolu, Aaron D. Viny, Jennifer E. Amengual, Barbara Pro, Susan E. Bates
Rapid advances in the field of epigenetics have facilitated the development of novel therapeutics targeting epigenetic mechanisms that are hijacked by cancer cells to support tumour growth and progression. Several epigenetic agents have been approved by the FDA for the treatment of cancer; however, the efficacy of these drugs is dependent on the underlying biology and drivers of the disease, with inherent differences between solid tumours and haematological malignancies. The efficacy of epigenetic drugs as single agents remains limited across most cancer types, which has spurred the clinical development of combination therapies, with the hope of attaining synergistic activity and/or overcoming treatment resistance. In this Review we discuss clinical advances that have been achieved with the use of epigenetic agents in combination with chemotherapies, immunotherapies or other targeted agents, including epigenetic–epigenetic combinations, as well as limitations and challenges associated with these combinatorial strategies. So far, the success of combination therapies targeting epigenetic mechanisms has generally been confined to haematological malignancies, with limited efficacy observed in patients with solid tumours. Nevertheless, this Review captures the field of epigenetic combination therapies across the spectra of haematology and oncology, highlighting opportunities for precision therapy to effectively harness the potential of epigenetic agents and produce meaningful improvements in clinical outcomes. Increased recognition of the roles of epigenetic reprogramming in cancer has spurred the development of epigenetic therapies, although these drugs have meaningful efficacy as single agents in only a narrow range of malignancies. In this Review, the authors discuss advances and pitfalls in the use of epigenetic drugs combined with chemotherapies, immunotherapies or other targeted agents, including epigenetic–epigenetic combinations.
{"title":"Getting the right combination to break the epigenetic code","authors":"Seda S. Tolu, Aaron D. Viny, Jennifer E. Amengual, Barbara Pro, Susan E. Bates","doi":"10.1038/s41571-024-00972-1","DOIUrl":"10.1038/s41571-024-00972-1","url":null,"abstract":"Rapid advances in the field of epigenetics have facilitated the development of novel therapeutics targeting epigenetic mechanisms that are hijacked by cancer cells to support tumour growth and progression. Several epigenetic agents have been approved by the FDA for the treatment of cancer; however, the efficacy of these drugs is dependent on the underlying biology and drivers of the disease, with inherent differences between solid tumours and haematological malignancies. The efficacy of epigenetic drugs as single agents remains limited across most cancer types, which has spurred the clinical development of combination therapies, with the hope of attaining synergistic activity and/or overcoming treatment resistance. In this Review we discuss clinical advances that have been achieved with the use of epigenetic agents in combination with chemotherapies, immunotherapies or other targeted agents, including epigenetic–epigenetic combinations, as well as limitations and challenges associated with these combinatorial strategies. So far, the success of combination therapies targeting epigenetic mechanisms has generally been confined to haematological malignancies, with limited efficacy observed in patients with solid tumours. Nevertheless, this Review captures the field of epigenetic combination therapies across the spectra of haematology and oncology, highlighting opportunities for precision therapy to effectively harness the potential of epigenetic agents and produce meaningful improvements in clinical outcomes. Increased recognition of the roles of epigenetic reprogramming in cancer has spurred the development of epigenetic therapies, although these drugs have meaningful efficacy as single agents in only a narrow range of malignancies. In this Review, the authors discuss advances and pitfalls in the use of epigenetic drugs combined with chemotherapies, immunotherapies or other targeted agents, including epigenetic–epigenetic combinations.","PeriodicalId":19079,"journal":{"name":"Nature Reviews Clinical Oncology","volume":"22 2","pages":"117-133"},"PeriodicalIF":81.1,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142760314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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