C2c: turning cancer into chronic disease.

Abstract

Despite fantastic progress in research over the past decade, cancer remains a major source of mortality worldwide. In the UK, for instance, cancer overtook circulatory diseases as the leading cause of death in 2011 [1]. Early detection would obviously be best to reduce this burden, but it requires exquisitely sensitive technology and population-wide screening programs. Short of finding a cure for cancer, turning cancer into a clinically manageable chronic disease like diabetes would be a major step forward. In this Editorial, we introduce a Genome Medicine series on cancer epigenomics [http://genomemedicine.com/series/cancerepigenomics], and discuss progress towards turning cancer into chronic disease with a focus on epigenomics. For cancers for which appropriate treatment options are available, the proposed cancer to chronic disease (C2c) approach (Figure 1) requires two key components: first, knowledge of the precise localization and quantification of the cancer burden anywhere in the body, which can be achieved by non-invasive whole-body imaging [2,3]; and second, knowledge of the precise molecular signature of the evolving cancer burden to reiteratively tailor treatments predicted to be most effective in combating the establishment of resistance and subsequent relapse. This can be achieved by (epi)genomic profiling of cancer-specific components isolated from minimally invasive blood samples, also known as liquid biopsies [4]. After all, ‘Blut ist ein ganz besonderer Saft,’ as already noted by Faust - the scholar who was striving to know everything - in Johann Wolfgang von Goethe’s 1808 play Faust Part I[5]. Figure 1 Illustration of the cancer to chronic disease (C2c) approach. (a) C2c core technologies: liquid biopsies (LB) and whole-body imaging (IM). For LB, current assays include circulating tumor cells and circulating tumor DNA as well as microRNAs. Examples ...