Cancer epigenomics on precision medicine and immunotherapy

Abstract

Immunotherapy has rapidly become one of the most promising therapeutic approaches for cancer patients. While significantly improving patients' survival, immunotherapy presents a unique toxicity profile. However, a large proportion of patients do not achieve optimal and durable responses, due in part to the lack of specific molecular markers that can comprehensively guide patient and therapeutic selection. Precision medicine, involving therapeutic decisions fine-tuned to the genetic makeup of an individual's tumor, has the potential to profoundly improve the outcomes of patients treated with immunotherapy. Yet, understanding the influence of genetic variations on immunotherapy is just one aspect of developing precision medicine strategies. Epigenomics, and the advent of optimized epigenetic drugs, is emerging as a powerful tool to expand the potential of precision medicine in cancer immunotherapy. The human epigenome represents an exceptional roadmap providing a wealth of information about specific interactions between an individual's genetic variations and environmental influences. This chapter is focused on the utility in precision medicine of epigenetic variations in the immune-response and immune-escape, and on potential applications for epigenetic therapies.