
Precision Oncology: Epigenetic Patterns Predict Glioblastoma Outcomes - sciadvance
https://directorsblog.nih.gov/2016/12/06/precision-oncology-epigenetic-patterns-predict-glioblastoma-outcomes/
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apathy
Interested to hear how this is "precision oncology". Do the 5hmC patterns
predict treatment response? (Spoiler: no, because this was retrospective; need
a trial to validate) Do they provide information above and beyond IDH or
co-1/19 status? (Spoiler: also no, partly because N=30 instead of over 1,000
in the TCGA LGG/GBM cohort)

I would expect this from the PR organs of a major university or other
donation-pandering body. I am saddened to see it from Collins, who knows
better. The treatments that seem to work in glioblastoma center on dendritic
cell vaccines or T-cell priming, at least at this point in time. Radiation is
a temporary respite and only succeeds for focal (rather than diffuse) lesions
in most cases; furthermore, "success" is relative (very few GBM cases are
cured, even in younger patients).

So while trials are afoot doing the brutally difficult work of evaluating
actual candidates for cures, we're directed towards studies of marks that are
almost certainly a proxy for metabolic activity. In bulk cells, natch. Way to
go.

:-(

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nrau
My mother unfortunately passed away from this horrible disease many years ago
when I was not yet 10 years old. Even more unfortunate is that life expectancy
once one is diagnosed with glioblastoma today is not any longer than it was
back then (35 years ago). Patients on average live 8-12 months. It's
depressing to see this, and I hope we can make bigger strides in the years
ahead.

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WhitneyLand
Looks like it is slightly better now. Standard cases have life expectancy of
2-3 years and very aggressive cases are at 14.6 months.

Either way a devastating cancer, sorry you had to go through that.

[http://www.abta.org/brain-tumor-information/types-of-
tumors/...](http://www.abta.org/brain-tumor-information/types-of-
tumors/glioblastoma.html)

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kensai
Just a reminder: the guidelines for gliomas (brain tumors) have been updated
after almost 10 years. And the outcome is more than ever decided at a
molecular level. I am pretty sure this kind of information will be included in
the next version.

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telchar
Just checking, do you mean "haven't been updated"?

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niels_olson
Hi, pathologist here. Keeping up with updates to classification schemes is a
non-trivial part of our practice. To the point that many visit the CAP
protocols before signing out any malignant case, just to make sure they're
going from the most current template. We actually have a lecture on the most
recent classification of lymphoid neoplasms tomorrow morning. And we had the
second part of the neuro update as a lecture from our neuropathologist last
week.

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gmarx
Makes sense. An interesting question is what causes the epigenetic
modifications that drive the tumor forward. Do the driver mutations also cause
these modification? Is it random and these cells are selected for?

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epistasis
It's also the other way around: the epigenetic state and physical conformation
of the genome drives what subsequent mutations happen.

Mina Bissel has been doing great work over the past 30 years showing that many
breast "cancer" cell lines lose their cancer phenotype when they're in the
proper 3D structures.

Mutations are a key part of cancer, but they're not sufficient to be the sole
drivers of carcinogenesis.

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gmarx
You mean when the chromosomes are in their proper structures? What messes up
the physical conformation of the chromosomes? Is it a combination of existing
mutation and epigenitic mods? Or something else?

