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November 28th, 2017

From pharmacogenomics to pharmaco-omics – individualized care for every patient

By Sharon Rosen

When prescribing a medication for you, your physician considers many factors, including your age, sex, weight and current health conditions. Now, add to that list your unique genetic characteristics. Your genes affect the way you respond to medications. Pharmacogenomics is a term used to describe the use of genomic information to help select the right medication for patients to maximize the treatment benefit and avoid harmful, sometimes life-threatening side effects.

It turns out that virtually everyone has a genetic variant that will affect the way they respond to one or more medications. Pharmacogenomics is already making a difference by helping individualize treatments for cancer, pain management, transplants and depression.

Richard Weinshilboum, M.D.

“This area of clinical genomics applies to every medical specialty and will eventually touch the care of every patient. While we are just at the beginning of understanding how genomics affect drug response, research has shown the benefit of using pharmacogenomics in clinical care. Pharmacogenomics information is being generated in clinical laboratories, added to electronic health records and used to ‘tailor’ or individualize therapy for patients,” says Mayo Clinic’s Richard Weinshilboum, M.D.

Dr. Weinshilboum and Liewei Wang, M.D., Ph.D., are leading pharmacogenomics researchers and co-directors of the Mayo Clinic Center for Individualized Medicine Pharmacogenomics Program. In the November issue of Mayo Clinic Proceedings, Dr. Weinshilboum and Dr. Wang trace the origins and development of pharmacogenomics and highlight the progress and challenges of implementing it into clinical practice. In their paper Pharmacogenomics:  Precision Medicine and Drug Response, they describe a vision for the future where pharmacogenomics will become “pharmaco-omics” in which other biological factors along with genomics are used to guide every medical drug-related therapy decision.

Using pharmacogenomics in patient care – progress and challenges

The challenge of using pharmacogenomics in clinical care is identifying the most cost-effective and efficient way to:

  • Add patients’ genomic information (known drug-gene interactions) and clinical guidelines into the electronic health record.
  • Bring this information together in an easy to understand format so clinicians can easily access it to select the best medication for each patient.

The authors highlighted several pilot studies underway that are testing these processes, including those at Mayo.

Currently, information for 19 drug-gene pairs is already added to Mayo's electronic health record. This information can trigger an alert along with clinical guidelines to any clinician prescribing a medication in which a patient’s genomics could affect their response to the drug.

Liewei Wang, M.D., Ph.D.

“While having drug-gene information incorporated into the electronic health record is helpful, clinicians may still need to order genetic testing for a patient before they can use this information, potentially delaying treatment decisions. Through the RIGHT 10K study, we are investigating the benefit of pre-emptively adding a patient’s genomic information, along with clinical guidelines on how to interpret and use this information. This allows clinicians to have information they need when prescribing medications,” explains Dr. Wang.

The future – new discoveries will enhance individualized care

Going forward, the authors forecast that many new discoveries will help guide drug selection, including:

  • Rapid increase in the number of genetic variants associated with medication response – from hundreds to thousands of variants per gene.
  • Growing amount of available genomic data as researchers explore the genome for drug-gene interactions by using new DNA sequencing technologies.
  • New findings about other biological measures that affect drug response that can be used along with genomics to guide treatment selection.

The challenge will be to develop computational tools and computer systems to analyze, interpret and then translate this wealth of information into guidelines to help physicians select the most effective medication for each individual patient.

According to the authors, despite these challenges, this area of precision medicine has the potential to help every patient.

Mayo Clinic Proceedings Symposium on Precision Medicine 

This paper is the seventh in the Mayo Clinic Proceedings Symposium on Precision Medicine, a series of articles that cover a wide range of topics in personalized medicine. Watch for upcoming articles in the symposium, which will focus on how personalized medicine and genomics are impacting patient care. Learn more about the series.

Join the conversation

For more information on the Mayo Clinic Center for Individualized Medicine, visit our blogFacebookLinkedIn or Twitter at @MayoClinicCIM.

See highlights from our recent Individualizing Medicine Conference 2017: Advancing Care Through Genomics:

Save the date for next year’s Individualizing Medicine Conference. It will be held Sept. 11-12, 2018.

 

 

Tags: #drug-gene interactions, #pharmacogenomics testing, #RIGHT 10K study, center for individualized medicine, Dr. Liewei Wang, Dr. Richard Weinshilboum, individualized medicine, mayo clinic, Mayo Clinic Proceedings, pharmacogenomics, Precision Medicine

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