Patient profiling for treatment toxicity: potential use of clinical and genomic factors

Significant advances have been made in the identification of genes associated with the occurrence and prognosis of a variety of cancers. Recent efforts have also identified specific genomic single nucleotide polymorphisms (SNPs) that are associated with treatment toxicity in oncology, including toxicity associated with irinotecan, 5-FU, and 6-mercaptopurine. Despite the identification of these potential genomic predictors, their clinical use has been limited. Recent work has identified combined clinical characteristics and SNPs associated with toxicity with temozolomide. This combined approach may allow for identification of those at risk, and by using clinical parameters for screening, further refine those who require the more expensive genomic testing. This approach, as well as evaluation of clinical utility, economic impact, and ease of use are important components necessary for evaluation and use of genomic predictors of toxicity in the future.