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PHARMACOGENOMICS (PGx)

Cancer and Immunosuppressive PGx Test Panel

Cancer and Immunosuppressive PGx Test Panel

MTHFR, TPMT, CYP2D6, CYP3A4, CYP3A5

Many of anti-cancer medications are under influence of genetics. Standard chemotherapy may eradicate for example breast cancer in some of affected individuals but work less effectively in others. Genetic make-up of individuals may explain the differences in drug response. In addition to cancer medications, pharmacogenetics may have implications for immunosuppressive medications. Precision prescribing of immunosuppressive medications such as tacrolimus can help with management of transplant recipients.

 

Anti-Cancer and immunosuppressive medications

Medication Gene
Thiopurines (azathioprine, mercaptopurine, thioguanine) TPMT
Methotrexate MTHFR
Tamoxifen CYP2D6
Gefitinib CYP2D6
Tacrolimus, Cyclosporine, Sirolimus CYP3A4, CYP3A5

 

Frequency of Cytochrome P450 (CYP2D6) Metabolizer Types in the population

Cytochrome Poor metabolizer Intermediate metabolizer Normal metabolizer Rapid or ultra-rapid metabolizer
CYP2D6 4-7% 9-35% 50-90% 2-3%

 

Drug To Drug Interaction

For drug-drug interactions, please go to Flockhart Table ™

References

  • Evans WE, McLeod HL. Pharmacogenomics -- Drug Disposition, Drug Targets, and Side Effect. The New England Journal of Medicine. 2003;348(6):538-549.
  • Huang RS, Ratain MJ. Pharmacogenetics and pharmacogenomics of anticancer drugs. CA Cancer J. Clin. 2009;59(1):42–55
  • Matthew P. Goetz, Katrin Sangkuhl, Henk-Jan Guchelaar, Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 and Tamoxifen Therapy, Clin Pharmacol Ther 2018 May;103(5):770-777
  • Black AJ, McLeod HL, Capell HA, et al. Thiopurine methyltransferase genotype predicts therapy-limiting severe toxicity from azathioprine. Ann Intern Med. Nov 1 1998;129(9):716-8.
  • Birdwell KA, Decker B, Barbarino JM, et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for CYP3A5 genotype and tacrolimus dosing. Clinical Pharmacology and Therapeutics. 2015;98(1):19-24. doi:10.1002/cpt.113
  • https://cpicpgx.org/genes-drugs
  • https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling
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