By Kayt Sukel
It’s said that the era of clinical genomics is upon us—and, certainly, the promise of pharmacogenetics, or the use of genomic data to understand an individual’s response to drugs both in terms of therapeutic result and potential side effects, is developing into an important player in the design of individualized cancer treatments. But as the field of pharmacogenetics has moved beyond the oncology ward, and into the emergency room and the mental health clinic, one big question looms: How does the average clinician make sense of all this new data?
“There are two aspects to this pharmacogenetics revolution: The first is using genetic information to tell us how individuals might respond to a particular drug. This has become important in cancer drugs—especially since cancer drugs, by nature, are incredibly toxic,” says Daniel Brazeau, the director of genomics, analytics and proteomics at the University of New England’s College of Pharmacy. “But the other area that is emerging is the one where we can use genomic technologies to individualize a particular disease so we can really understand the nature of the underlying problem at the molecular level. And if we can do that, then we have an opportunity to specifically target the treatment there.”
But that means trying to make sense out of what might amount to a lot of data, and Brazeau says, to date, it’s unclear what to do with the vast majority of that information.
“It won’t be long before sequencing a genome will cost around $1,000—which is on par with a regular laboratory test,” he says. “So physicians will have access to an individual’s genome, perhaps even at birth. And that’s going to revolutionize the way we think about how to treat patients and how to prescribe drugs.”
But there is a bottleneck to making that promise a reality. While some might argue that technology is not where it should be to support genomic clinical decision-making, Brazeau says the true gap is in clinical education.
“You have a huge number of healthcare professionals who have only a basic genetics background. So, to start, genetics and genomics needs to become part of training in medical, nursing and pharmacy school,” he says. “Clinicians don’t need to worry so much about the technologies. But they need to have a good understanding of the nature of the genome, the nature of polymorphisms, and what it means to have a gene with a lot of mutations and how that might affect a phenotype. And that training needs to be ongoing.”
Clinicians now have access to genetic testing services like GeneSight from Assurex Health—tests that help physicians make prescribing more personal and more effective. Furthermore, these tests use bioinformatics to make sense of the wealth of data, reducing the burden on clinicians by making results easy to understand.
Still, Brazeau says it would be good for clinicians to have the background necessary to make sense of the data on their own and put it in the proper context for diagnosis.
“We are way behind in training the next generation of clinicians,” he says.”[Genomics] is a piece that clinicians need to better understand in order to put it in the right place so they can help their patients.”