Translating Tumor Genetics into Clinical Practice
The process of performing and interpreting tumor genomics for use in an actionable treatment plan is vital in oncology practice, according to a presentation given by Christine M. Walko, PharmD, BCOP, FCCP, Personalized Medicine Specialist, and Chair of the Clinical Genomic Action Committee (CGAC) of the Moffitt Cancer Center in Tampa, FL.
Using cancer genes to guide treatment decisions is a component of precision cancer medicine as genetic alterations in molecular pathways play a role in the development, survival, and progression of tumors. Fortunately, recent technological advancements enable physicians to profile these alterations. Genetic alternations often serve as indicators of the benefit or resistance of a particular cancer therapy and can provide diagnostic and prognostic information that can be implemented in a clinical action plan. Moreover, while clinically relevant germline alterations inform cancer risk, and pharmacokinetics, germline challenges arise if a tumor is analyzed with matched normal tissue, and presents an allele frequency of 50% of 100%, which may suggest germline alterations in some assays.
In translating alteration recommendations into clinical decision making, it’s important to present all available data to facilitate the decision-making process, while also considering the interaction of all the respective mutations together. The physician must also consider each patient’s unique characteristics (e.g., desire for a clinical trial and ability to travel, availability and ability to qualify for a clinical trial, sequencing of treatment options, insurance coverage and ability to afford label therapy, and his/her treatment course). In addition, the presenter noted barriers to implementing genomically-guided therapy in oncology which include time restraints, electronic medical record specifics (e.g., is the system capable of adapting to your needs?” and the need for collaboration within your institution (e.g. pathologists and pharmacists have different skill sets that can be highly complementary), plus the financial means to support these endeavors.
In her conclusion, the presenter wrote that implementing tumor genetics into a clinical setting can “translate our understanding of cancer biology crosstalk and feedback signaling into rationale drug combinations, improve biomarker identification and validation to target the right genetic drivers, and improve the risk/benefit ratio when testing precision medicine strategies.”
Walko C. Translating Tumor Genetics into Clinical Practice. Presented at the Hematology/Oncology Pharmacy Association Annual Conference; April 3-6, 2019; Fort Worth, TX.
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