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Clinical practice guidelines for translating pharmacogenomic knowledge to bedside. Focus on anticancer drugs
José A G Agúndez1, Gara Esguevillas1, Gemma Amo1
1Department of Pharmacology, University of Extremadura Cáceres, Spain ; ISCIII Research Network of Adverse Reactions to Allergens and Drugs Madrid, Spain.
Abstract:
The development of clinical practice recommendations or guidelines for the clinical use of pharmacogenomics data is an essential issue for improving drug therapy, particularly for drugs with high toxicity and/or narrow therapeutic index such as anticancer drugs. Although pharmacogenomic-based recommendations have been formulated for over 40 anticancer drugs, the number of clinical practice guidelines available is very low. The guidelines already published indicate that pharmacogenomic testing is useful for patient selection, but final dosing adjustment should be carried out on the basis of clinical or analytical parameters rather than on pharmacogenomic information. Patient selection may seem a modest objective, but it constitutes a crucial improvement with regard to the pre-pharmacogenomics situation and it saves patients' lives. However, we should not overstate the current power of pharmacogenomics. At present the pharmacogenomics of anticancer drugs is not sufficiently developed for dose adjustments based on pharmacogenomics only, and no current guidelines recommend such adjustments without considering clinical and/or analytical parameters. This objective, if ever attained, would require the use of available guidelines, further implementation with clinical feedback, plus a combination of genomics and phenomics knowledge.
Insights
Clinical pharmacogenomics improves anticancer drug therapy by aiding patient selection. Current guidelines recommend using pharmacogenomic testing for selection, not sole dose adjustment, prioritizing patient safety.
Area of Science:
- Pharmacogenomics
- Clinical Pharmacology
- Oncology
Background:
- Clinical practice recommendations for pharmacogenomics are crucial for optimizing drug therapy, especially for toxic anticancer drugs.
- Despite recommendations for over 40 anticancer drugs, few clinical practice guidelines exist.
Purpose of the Study:
- To assess the current state and utility of pharmacogenomic data in clinical practice guidelines for anticancer drugs.
- To highlight the role of pharmacogenomics in patient selection versus dose adjustment.
Main Methods:
- Review of existing clinical practice guidelines and recommendations for pharmacogenomic testing in oncology.
- Analysis of the current evidence supporting pharmacogenomic use for patient selection and dose adjustment.
Main Results:
- Published guidelines indicate pharmacogenomic testing is valuable for patient selection in cancer therapy.
- Current guidelines do not support sole pharmacogenomic-based dosing adjustments, emphasizing clinical or analytical parameters.
Conclusions:
- Pharmacogenomics significantly improves patient selection for anticancer drugs, enhancing safety and efficacy.
- Full pharmacogenomic-based dose adjustment for anticancer drugs is not yet feasible and requires further research combining genomics and phenomics.
