"Now, what we found is that epigenetics is actually heritable and it's actually reversible. And we can now manipulate these principles with pharmacotherapy drugs," Eric Zack, RN, OCN®, BMTCN®, clinical assistant professor at Loyola College Chicago Marcella Niehoff School of Nursing in Chicago, IL, and RN3 at Rush University Medical Center in Chicago, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the epigenetics drug class.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Earn 0.75 contact hours (including 40 minutes of pharmacotherapeutic content) of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by February 28, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to the epigenetics drug class.

Episode Notes

• Complete this evaluation for free NCPD.
• ONS Podcast™ Pharmacology 101 series
• ONS Voice articles:
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  • Oncology Drug Reference Sheets
  • What Is MCED Testing?
• ONS book: Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (Fourth Edition)
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• ONS course: Genomic Foundations for Precision Oncology
• ONS Huddle Card: Financial Toxicity
• ONS Learning Libraries:
  • Genomics and Precision Oncology
  • Oral Anticancer Medication
• American Cancer Society: Patient Programs and Services
• Centers for Disease Control and Prevention: Epigenetics, Health, and Disease
• Leukemia & Lymphoma Society: Financial Support
• National Institutes of Health: Epigenetics
• University of Pennsylvania: Epigenetics Institute
• University of Utah: Genetic Science Learning Center

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Highlights From This Episode

"Epigenetics is influenced by several factors. Right now, there's about seven of them that we've identified, and we can only manipulate right now about two of those seven. So the first one is DNA methylation. When you methylate DNA, that's adding or subtracting a methyl group, which is CH3, chemically. The addition of methyl to DNA tightens the DNA around the chromatin, which then can block some genes from being expressed." TS 7:21

"Histones basically package DNA into the chromatin, which is a mixture of DNA and proteins, and they spool around this structure like the DNA is coiled around that. And again, it has to do with how tight or loose that is coiled. That determines if the genes are expressed or not. And again, we found that histones also play a role in DNA repair as well as regulating the cell cycle." TS 8:21

"When we're dealing with the azacitidine and decitabine, these drugs cause pancytopenia. Pancytopenia is neutropenia, thrombocytopenia, and anemia. So it affects the complete blood count. We see GI toxicity, nausea, vomiting, diarrhea, constipation, sometimes mouth sores, and urticaria—hives." TS 15:34

"It's really, really important to take these drugs exactly as they are prescribed. They have to follow the doctor's orders carefully, which requires taking them properly, doing the proper follow up. There's a lot of blood tests and appointments that we have to do to make sure that everything is okay. And again, because we know when there is nonadherence, the disease progresses and becomes resistant, so that's a really, really important teaching point. We have to monitor the patient for expected side effects and unexpected side effects." TS 23:58

"Now, we expect the landscape to change dramatically over the next few years. And again, it's just an explosion of science information. As we learn more about the science, it's going to translate into practice. We're always identifying new biomarkers. These biomarkers are essentially DNA mutations or variations. There's so many variants of unknown significance." TS 30:02

"Every patient deserves biomarker testing. Very important, whether it's through IHC, polymerase chain reactions, or the most common next-gen sequencing. Again, there's several companies out there that have standard kits available." TS 31:33

"This is a precision medicine. This is what we've always dreamed about—tailoring the treatment to the specific patient. We've gone away from treating standard diseases, like lung cancer and breast cancer, the way they're supposed to be treated to now looking at these biomarkers and using epigenetic drugs and other medications tailored to those variants that that patient is having, not necessarily based on their disease type." TS 33:59