癌症异质性和耐药性仍然是有效癌症治疗和管理的关键障碍。造成这些挑战的一个主要因素是表观遗传修饰，即不涉及 DNA 序列本身变化但显着影响基因表达的基因调控。当我们阐明这些现象时，我们强调表观遗传修饰在调节基因表达、促进细胞多样性以及驱动可引发治疗耐药的适应性变化方面的关键作用。这篇综述剖析了重要的表观遗传修饰——DNA甲基化、组蛋白修饰和染色质重塑——说明它们对癌症生物学的重要而复杂的贡献。虽然这些变化由于其可逆性而为治疗干预提供了潜在的途径，但癌细胞中表观遗传和遗传变化的相互作用提出了独特的挑战，必须解决这些挑战才能充分发挥其潜力。通过批判性地分析当前的研究格局，我们确定知识差距并提出未来的研究方向，探索表观遗传疗法的潜力并讨论将这些概念转化为有效治疗的障碍。这项全面的审查旨在促进进一步的研究并帮助开发创新的、以患者为中心的癌症疗法。了解表观遗传修饰在癌症异质性和耐药性中的作用对于科学进步至关重要，并为改善患者对抗这种可怕疾病的治疗结果铺平道路。版权所有 © 2023。由 Elsevier Inc. 出版。

Cancer heterogeneity and drug resistance remain pivotal obstacles in effective cancer treatment and management. One major contributor to these challenges is epigenetic modifications - gene regulation that does not involve changes to the DNA sequence itself but significantly impacts gene expression. As we elucidate these phenomena, we underscore the pivotal role of epigenetic modifications in regulating gene expression, contributing to cellular diversity, and driving adaptive changes that can instigate therapeutic resistance. This review dissects essential epigenetic modifications - DNA methylation, histone modifications, and chromatin remodeling - illustrating their significant yet complex contributions to cancer biology. While these changes offer potential avenues for therapeutic intervention due to their reversible nature, the interplay of epigenetic and genetic changes in cancer cells presents unique challenges that must be addressed to harness their full potential. By critically analyzing the current research landscape, we identify knowledge gaps and propose future research directions, exploring the potential of epigenetic therapies and discussing the obstacles in translating these concepts into effective treatments. This comprehensive review aims to stimulate further research and aid in developing innovative, patient-centered cancer therapies. Understanding the role of epigenetic modifications in cancer heterogeneity and drug resistance is critical for scientific advancement and paves the way towards improving patient outcomes in the fight against this formidable disease.Copyright © 2023. Published by Elsevier Inc.