15. Historically,
Cancer Was Considered
to be Driven Mostly by Genetic Changes
GENETIC
Mutations in p53
Example:
Replication errors
Activating mutations in RAS
Mutations or amplifications of the
X X
HER-2 gene
Altered
DNA sequence
Chromosomal translocations in
Altered
DNA/mRNA/proteins
Oncogenesis
myeloid cells and the generation of
the BCR-ABL fusion protein
Tumor
16. Epigenetic Changes are
Important in Causing Cancer
GENETIC
EPIGENETIC
Example:
Chromatin modification errors
Example:
Replication errors
X X
Altered
chromatin structure
Altered
DNA sequence
Altered
DNA/mRNA/proteins
Oncogenesis
Altered levels of
mRNA/proteins
Tumor
17. Example of Methylation
vs Mutation: Colon & Breast Cancer
120
100
80
Dx
60
40
CDx
20
0
Methylated
Mutated
Source: Schuebel et al 2007
76-100 51-75
21-50
1-20
18. MGMT Biology
O6 Methyl-Guanine
Methyl Transferase
Essential DNA Repair Enzyme
Removes alkyl groups from damaged
guanine bases
Healthy individual:
- MGMT is an essential DNA repair enzyme
Loss of MGMT activity makes individuals susceptible
to DNA damage and prone to tumor development
Glioblastoma patient on alkylator chemotherapy:
- Patients with MGMT promoter methylation show
have longer PFS and OS with the use of alkylating
agents as chemotherapy
19. MGMT Promoter
Methylation Predicts
Benefit form DNA-Alkylating Chemotherapy
Post-hoc subgroup analysis of Temozolomide Clinical trial with primary
glioblastoma patients show benefit for patients with MGMT promoter methylation
25
Median Overall Survival
21.7 months
20
15
plus
temozolomide
12.7 months
radiotherapy
10
radiotherapy
5
0
Non-Methylated
MGMT Gene
Methylated
MGMT Gene
Adapted from Hegi et al.
NEJM 2005
352(10):1036-8.
Study with 207 patients
53. Acknowledgments
Geert Trooskens
Simon Denil
Klaas Mensaert
Jean-Pierre Renard
Sarah De Keulenaer
Ellen De Meester
Tim De Meyer
Wim van den Berghe
Manon Van Engeland
Jurgen Veeck
Monika Hegi
Pierre Bady
Sebastian Kurscheid
Olivier Thas
53