July 7, 2019  |  

Precision medicine and rare genetic variants.

Interindividual variability in drug metabolism and drug toxicity persists as a major problem for drug development and treatment. Increased or decreased capacity for drug elimination or drug action reduces drug efficacy and places substantial economic burdens on society (e.g., due to treatment of adverse drug reactions) [1]. To a great extent this variation is based on genetic differences, and indeed many drugs now carry pharmacogenomic labels regarding mandatory or informative genetic tests that have to/can be performed before prescription (http://www.fda.gov/drugs/ scienceresearch/researchareas/pharmacogenetics/ucm083378.htm).Theselabelsarebasedonthe most common allelic variants in germline or somatic genes with importance for drug metabolism that encode phase I or phase II enzymes, transporters, or drug targets. In many cases, particularly in oncology, these labels are major determinants of successful treatment. However, the question arises of to what extent these labels are useful for future precision medicine encompassing specific patients carrying mutations not commonly seen in the whole population.


July 7, 2019  |  

Implementation of pharmacogenomics in everyday clinical settings.

Currently, germline pharmacogenomics (PGx) is successfully implemented within certain specialties in clinical care. With the integration of PGx in pharmacotherapy multiple stakeholders are involved, which are identified in this chapter. Clinically relevant pharmacogenes with their related PGx test are discussed, along with diagnostic test criteria to guide clinicians and policy makers in PGx test selection. The chapter further reviews the similarities and the differences between the guidelines of the Dutch Pharmacogenetics Working Group and the Clinical Pharmacogenetics Implementation Consortium which both support healthcare professionals in understanding PGx test results and help guiding pharmacotherapy by providing evidence-based dosing recommendations. Finally, clinical studies which provide scientific evidence and information on cost-effectiveness supporting clinical implementation of PGx in clinical care are discussed along with the remaining barriers for adoption of PGx testing by healthcare professionals.© 2018 Elsevier Inc. All rights reserved.


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