BETHESDA, MD 29 August 2013—In five years, predicted Casey B. Williams, clinicians won’t be treating lung cancer or breast cancer.
“We’re going to be treating the mutation-of-choice tumor, and it may be located in the lung, or it may be located in the kidney, or it may be located in the liver,” said Williams, clinical director for research at the Edith Sanford Breast Cancer Initiative in Sioux Falls, South Dakota. “But we’re not going to be treating specific tissue tumors. We’re going to be treating mutation-based, genomically based diseases.”
And if practicing pharmacists do not prepare for pharmacogenomics-based medicine, he said, “we’re going to be left in the dust” of those practitioners who do prepare.
Williams’s comment came as the National Coalition for Health Professional Education in Genetics prepared to close after 17 years of operation.
The coalition released “Core Competencies For All Health Professionals” in 2007. A search of the group’s website in August 2013, however, did not reveal any resources that the coalition had developed specifically for pharmacists.
Like Williams, James M. Hoffman at St. Jude Children’s Research Hospital in Memphis and John Valgus at the University of North Carolina Hospitals and Clinics in Chapel Hill see pharmacogenomics soon becoming a strong influence in the selection and management of drug therapies.
These three pharmacists—whose work routinely involves pharmacogenomics—suggested some resources for pharmacists who want to know more this year.
Clinical Pharmacogenetics Implementation Consortium’s guidelines. The four-year-old Clinical Pharmacogenetics Implementation Consortium (CPIC) creates guidelines on how to interpret the results of genetic tests and then optimize drug therapy.
As of August 9, CPIC had published guidelines on applying the results of specific genetic tests to the use of the following drugs or classes of drugs: abacavir, allopurinol, carbamazepine, clopidogrel, codeine, simvastatin, thiopurines, tricyclic antidepressants, and warfarin.
All of the guidelines can be accessed from www.pharmgkb.org/page/cpicGeneDrugPairs.
Those on clopidogrel and codeine have been endorsed by the ASHP Board of Directors, at the recommendation of the Council on Therapeutics.
Hoffman, a medication outcomes and safety officer, said his facility uses CPIC’s guidelines in creating clinical decision support for the electronic health record.
“We’re going to have more and more of these [genetic test] results available, and it’s going to be really impossible for any one clinician to keep track of” which genotypes affect the medication under consideration, he said.
Hoffman is one of nine St. Jude Children’s employees who are members of CPIC. His coworker Mary V. Relling leads the CPIC team.
ASHP Emerging Sciences resource center. Valgus, who recently completed two years as chair of the Section Advisory Group on Emerging Sciences, part of the ASHP Section of Clinical Specialists and Scientists, recommended the pharmacogenomics area of the Emerging Sciences online resource center.
The resource center’s Pharmacogenomics page, at www.ashp.org/menu/PracticePolicy/ResourceCenters/
Emerging-Sciences/Pharmacogenomics, offers links to relevant articles, books, education, presentations from ASHP meetings, and external resources.
Incoming vice chair Williams said the group’s goal is to “build [in] more of a basic provision of education” to practicing and student pharmacists. But some of the educational material the group would like to make available is protected by copyright, he said.
Williams said the Pharmacogenomics page, as it grows, will offer general material as well as material specific to a specialty, such as oncology or cardiology.
Genetics/Genomics Competency Center for Education. Coming this fall is the pharmacists’ section of Genetics/Genomics Competency Center for Education, at www.g-2-c-2.com, Hoffman said.
The center is a project of the National Human Genome Research Institute, part of the National Institutes of Health.
Spearheading the effort to add pharmacist education resources to the center are Hoffman, Grace M. Kuo of the University of California—San Diego, Reginald F. Frye of the University of Florida in Gainesville, and Mary W. Roederer of the University of North Carolina.
“We went through a process to identify resources to post on the site,” Hoffman said, adding that the group used as its guide the competency statements from the National Coalition for Health Professional Education in Genetics. “Now we’re nearly complete.”
The Midyear 2013. Williams said a one-hour educational session that the Section of Clinical Specialists and Scientists is planning for the ASHP Midyear Clinical Meeting will cover pharmacogenomics in clinical practice.
He said the content of the session is not focused on one particular area but cardiology and oncology will predominate.
“What we’re doing now in oncology is we’re doing a whole-genome sequence and understanding [and] coming up with the drivers of what actually is causing cancer for that particular patient,” Williams said.
Sequencing a person’s whole genome is no longer a rare undertaking, he said, because the technology is “cheaper” than before.
The cost to sequence a human-sized genome in September 2001 was about $95 million, according to the National Human Genome Research Institute. That was the year scientists published details of drafts of the reference sequence for the human genome. For April 2013, the institute-reported cost was $5826.
Coalition’s demise. The information at the website of the National Coalition for Health Professional Education in Genetics will be maintained by the American Society of Human Genetics.
In a statement, the society’s executive president, who served as the coalition’s executive director for 13 years, estimated the coalition’s website content as “no less than a $10 million investment.”