Pharmacological Modulation of DNA Damage Response Pathways in Cancer Therapy

Abstract

In cancer treatment, scientists are exploring ways to influence how cells respond to DNA damage. Cancer cells often have flaws in their DNA repair systems, which makes them more vulnerable to treatments that target those weaknesses. One approach is using medications that interfere with these repair mechanisms, effectively leading to the destruction of cancer cells while sparing healthy ones. For example, drugs known as PARP inhibitors, (such as olaparib and niraparib) block a key repair process in cells. This is especially effective in cancers with mutations in the BRCA genes, making them more susceptible to damage. Combining these therapies with immunotherapy or traditional chemotherapy is also being studied to enhance effectiveness. However, there are challenges, including resistance to treatment, potential side effects, and identifying the right patients who will benefit most. The DNA damage response (DDR) plays a pivotal role in preserving genomic integrity and preventing malignant transformation. Recent advances have underscored the therapeutic potential of pharmacologically targeting DDR pathways to exploit cancer-specific vulnerabilities. We highlight how these agents induce synthetic lethality in tumors with homologous recombination deficiency and replication stress, while also discussing combination approaches with chemotherapy, radiotherapy, and immunotherapy. Biomarker-driven strategies for patient selection, challenges in resistance development, and emerging trends in personalized treatment paradigms are also reviewed. By analyzing recent preclinical and clinical studies, this article provides an updated framework for leveraging DDR modulation as a precision oncology strategy, emphasizing both current challenges and future opportunities.