The DNA damage response (DDR) is essential for maintaining the genomic integrity of the cell and its disruption is one of the 'Hallmarks of Cancer'. Classically, defects in the DDR have been exploited therapeutically in the treatment of cancer by radiation therapies or by genotoxic chemotherapies. More recently, protein components of the DDR systems are being identified as promising avenues for targeted cancer therapeutics. Here we present an in-depth analysis of the function, disease role and therapeutic potential of ~450 expert-curated human DDR genes. We discuss the current state of DDR drugs both FDA approved or under clinical investigation. We examine large-scale genomic and expression data in 15 cancers to identify deregulated components of the DDR in these tumours, and we apply systematic computational analysis to identify DDR proteins amenable to modulation by small molecules, highlighting potential novel therapeutic targets.
3The DNA Damage Response (DDR) evolved in response to the exposure of the genome to exogenous and endogenous genotoxins. Unless repaired in an error-free process, DNA damage can result in mutations and altered cellular behavior. Consequently, cells deploy a diverse repertoire of mechanisms to maintain genetic integrity 1 (see TABLE 1). These mechanisms involve the DNA repair processes themselves, the systems that regulate and organize them, and the systems that integrate DNA damage repair with the cell cycle 2 .Disruption of the DDR is observed in many cancers [3][4][5] , and underlies the genomic instability that accompanies tumourigenesis and progression. However, in the majority of cases, the specific underlying defects are poorly characterised 6,7 . Conversely, there are well-described cancers where disruption of a DDR mechanism is directly causal. In addition to these licensed drugs, there are a number of compounds currently under clinical evaluation that target DDR pathways directly. These targets include the protein kinases involved in cell cycle DNA checkpoint for DNA damage and/or replicative stress (eg CHEK1, WEE1), and individual enzymes involved in base excision repair (BER; APEX1), direct repair (MGMT), non-homologous DNA double strand break repair (NHEJ; PRKDC / DNA-PK) and telomere maintenance (TM; TERT).The initial rationale for development of DDR enzyme-targeted drugs focused on their use as potentiators, inhibiting repair of damage caused by radiotherapy and/or conventional genotoxins 11 .However, this approach has been extended to stand-alone use, targeting DNA repair pathways critical to tumour survival by exploiting synthetic sensitivity/lethality 16 (SSL). SSL arises when a combination of loss-of-function in two or more genes leads to cell death, while loss-of-function in only one of them does not. The therapeutic aim is to exploit genetic defects essential to a tumour's survival by combining the defect in an affected pathway with a pharmacologically induced defect in a compensating pathway 17 .
4The best example to date is the pharmaceutical inhibition...