Integrating Pharmacogenomic Testing Into Paired Germline and Somatic Genomic Testing in Patients with Cancer

Abstract

Precision medicine has revolutionized clinical care for patients with cancer through the development of targeted therapy, identification of inherited cancer predisposition syndromes and the use of pharmacogenetics to optimize pharmacotherapy for anticancer drugs and supportive care medications. While germline (patient) and somatic (tumor) genomic testing have evolved separately, recent interest in paired germline/somatic testing has led to an increase in integrated genomic testing workflows. However, paired germline/somatic testing has generally lacked the incorporation of germline pharmacogenomics. Integrating pharmacogenomics into paired germline/somatic genomic testing would be an efficient method for increasing access to pharmacogenomic testing. In this perspective, the authors argue for the benefits of implementing a comprehensive approach integrating somatic and germline testing that is inclusive of pharmacogenomics in clinical practice.

CYP3A5 influences oral tacrolimus pharmacokinetics and timing of acute kidney injury following allogeneic hematopoietic stem cell transplantation

“…Expressers of CYP3A5 *1 spend significantly more time at subtherapeutic tacrolimus levels during the inpatient stay; however, once these patients reached therapeutic goals, the difference in AKI rates among patients with different genotypes disappeared. This finding is of significance clinically as proactive genotyping may help to identify patients who are at higher risk of early AKI development ( Seligson et al, 2023 ). Patients who are not expressers of CY3A5 *1 may require closer renal monitoring during the inpatient stay while expressers of CY3A5 *1 should be followed closely in the outpatient setting as they reach therapeutic goals.…”