Trends Cancer

Aberrant DNA methylation is a hallmark of cancer. Beyond its established diagnostic applications, growing evidence supports the utility of DNA methylation in predicting therapeutic response. By modulating gene expression patterns, particularly in pathways related to drug metabolism, DNA repair, and immune response, methylation profiles can directly influence how tumors respond to specific treatments. Although clinical implementation remains limited to a few examples, ongoing efforts to standardize assays, enhance sensitivity in liquid biopsy, and validate predictive markers in prospective trials will enable its full recognition as a dynamic, actionable decision-support tool for therapy selection and adaptive management of cancer treatment.