Despite being one of the main treatment options for cancer, there is wide variation in the incidence of Systemic anti-cancer treatment (SACT) – induced toxicity between individuals and institutions, leading to significant impacts for patients and the health service.
Inherited genomic variation (pharmacogenomics) can partly explain some of this variation in response to medicines. Pharmacogenomic test results can be used to optimise prescribing, reduce toxicity and improve effectiveness of medicines. Most individuals with cancer carry actionable pharmacogenomic variants, however for the result to be truly actionable, the individual must also be prescribed a medicine for which the result would be informative. Whilst single-gene pharmacogenetic testing has been routinely adopted in oncology in the UK and elsewhere for a small number of drug-gene pairs, the same cannot be said for multi-gene panel testing. Feasibility of this type of testing has been demonstrated in paediatric haemato-oncology, but the clinical utility across adult cancer populations remains uncertain.
This presentation will summarise the limited published evidence for implementation of pharmacogenomic panel testing in solid tumours globally to date, outlining the practical aspects of service delivery, outcome measurement and clinical impact. Our study conducted in the Northwest of England assesses the potential value of pharmacogenomic panel testing to inform prescribing of both anti-cancer and supportive medicines given to people receiving SACT. In a retrospective cohort study at a tertiary oncology hospital, we extracted prescribing data for over 13,000 individuals prescribed at least one cycle of SACT during the study period. We will describe the use of medicines with pharmacogenomic guidance across the study cohort, and the patient and disease characteristics associated with increased prescribing of pharmacogenomic medicines, where the potential value of pre-emptive testing may be higher.
Finally, the talk will explore the remaining evidence gaps to address before routine implementation of pharmacogenomic panel testing in cancer treatment pathways and the development of a competency framework resource to enable a prescribing workforce that can utilise results in practice for patient benefit.