[Theranostic impact of the epitranscriptome in oncology]

The rising incidence of cancer and the frequent resistance to treatments are driving the scientific community to explore new biological frontiers in search of concrete solutions for personalized patient care. These initiatives are made possible by the ongoing development of innovative technologies, which are shedding new light on our understanding of biological mechanisms. One such area is ribonucleic acid (RNA) chemical modifications-known as the epitranscriptome-which play a key role in all post-transcriptional stages of gene expression. An increasing number of studies are linking these modifications to tumor progression and treatment resistance. Functionally, epitranscriptomic modifications are orchestrated by a set of proteins known as "writers", "erasers" and "readers" which respectively add, remove, or read these chemical marks on RNA. The expression of these regulatory proteins is often dysregulated in cancer, thereby contributing to carcinogenesis. Clinically, these modifications are relevant across the entire patient care continuum, including diagnostic, prognostic, predictive, and therapeutic aspects. Many epitranscriptomic marks are associated with overall survival, tumor stage, the presence of metastases, or the detection of specific cancer types. They can enhance treatment efficacy or help anticipate resistance by modulating gene expression in target cells and revealing molecular signatures associated with therapeutic escape mechanisms. Moreover, inhibitors targeting epitranscriptomic regulatory proteins are currently under development and being evaluated in clinical trials, paving the way for novel therapeutic strategies in oncology.