Influence of Aberrant Epigenetic Changes and the Tumor Microenvironment in Ovarian Cancer Metastasis

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Diego Aviles, MD
David Warshal, MD
Michelle Buchbinder, PHD
Olga Ostrovsky, PHD


Metastasis in ovarian cancer is a primary driver of poor outcomes for patients because of its association with chemoresistance and low five-year survival rates. Epigenetic changes to gene expression in cancer cells are key factors that contribute to the high rates of metastasis and chemoresistance. However, ovarian cancer cells do not act alone. Once the cancer spreads to the omentum and peritoneum, it hijacks intercellular communication systems to transform neighboring cells within the tumor microenvironment into potent engines that produce critical growth factors that facilitate metastasis, chemoresistance, immune evasion, and invasion. By reversing these aberrant epigenetic modifications in cancer cells and the tumor microenvironment, novel epigenetic therapies can specifically target cancer cells while sparing healthy cells, minimizing toxicity to normal tissues. When combining these pharmaceutical agents with standard chemotherapy, metastasis and chemoresistance can be suppressed, making ovarian cancer cells newly susceptible to current cytotoxic treatments, and providing patients with hope for a cure.


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Chapter 6