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. Author manuscript; available in PMC: 2016 Oct 1.
Published in final edited form as: Trends Cancer. 2015 Oct 1;1(2):145–156. doi: 10.1016/j.trecan.2015.07.007

Figure 2.

Figure 2

Telomere maintenance mechanism (TMM) profiling of alternative lengthening of telomeres (ALT) may have clinical utility for diagnosis, prognosis, and treatment of ALT-positive tumors. Diagnosis could be determined through the C-circle (CC) assay with or without quantitative PCR (qPCR) techniques to increase sensitivity and specificity. Additionally, mutational profiling of ATRX/DAXX/H3.3 may predict ALT activity in some tumor types. These tests may facilitate monitoring for tumor formation in patients with syndromes predisposing to ALT-positive tumors or for tumor dynamics or recurrence of established ALT-positive tumors. Since ALT has prognostic value in many settings, identification of ALT could enable more informed treatment decisions. Finally, TMM profiling may allow for personalized telomere-targeted therapies. In particular, treatments to decrease or increase ALT activity could exploit vulnerabilities present in ALT-positive tumors and lead to selective cell killing. ATR inhibitors represent a promising therapeutic strategy. By targeting ALT, we may in principle benefit patients with ALT-positive tumors, including those that have escaped telomerase inhibitors through ALT activation.