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Personalized Medicine In The Treatment of Cancer

Personalized Medicine In The Treatment of Cancer. Elvin T. Price, Pharm.D.,Ph.D. Assistant Professor Pharmaceutical Sciences University of Arkansas for Medical Sciences. Objectives. Provide an introduction to the principles of pharmacogenetics/genomics (PGx) and personalized medicine (PM)

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Personalized Medicine In The Treatment of Cancer

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  1. Personalized Medicine In The Treatment of Cancer Elvin T. Price, Pharm.D.,Ph.D. Assistant Professor Pharmaceutical Sciences University of Arkansas for Medical Sciences

  2. Objectives • Provide an introduction to the principles of pharmacogenetics/genomics (PGx) and personalized medicine (PM) • Describe the clinical relevance of PGx/PM to the management of cancer • Provide insight on the future of PGx/PM and cancer

  3. Time Magazine May 27, 2013 “Her preventive mastectomy raises important issues about genes, health and risk”

  4. Personalized Medicine Is Headed Your Way • Direct to consumer genomics companies are becoming increasingly popular and the prices are becoming increasingly affordable.

  5. Personalized Medicine Is Headed Your Way

  6. Personalized Medicine Is Headed Your Way

  7. AMDPA and NMA MembersPersonalized Medicine Is Headed Your Way

  8. Introduction • Clinical observations of inherited differences in drug effects were first documented in the 1950s, giving rise to the field of pharmacogenetics, and later pharmacogenomics. • The early pharmacogenetic examples were those with distinct phenotypes that could be easily characterized, understanding of the molecular basis for the phenotypes came later.

  9. Genetic Variation

  10. Genetic Variability Influences Response to Pharmacotherapy

  11. Genetic Variability Influences Targets of Pharmacotherapy

  12. Genetic Variability Influences Drug Metabolism Enzymes

  13. Genetic Variability Influences Drug Metabolism: Transporters

  14. Moving Towards Pharmacogenomics Ann Intern Med 2006;145:749.

  15. Pharmacogenomics TARGETS TRANSPORTERS METABOLIZING ENZYMES PHARMACODYNAMICS PHARMACOKINETICS Variability in Efficacy/Toxicity

  16. The Goal of PGx and PM

  17. PGx Biomarkers Are Useful When Prescribing Tamoxifen

  18. Estrogen Receptor Status Influences Response To Tamoxifen Estrogen Receptor Negative Estrogen Receptor Positive Tumor Status

  19. CYP2D6 Genotypes Influence Response To Tamoxifen

  20. CYP2D6 and ABCC2 Genotypes Influence Response To Tamoxifen

  21. CYP2D6 and ABCC2 Genotypes Influence Response To Tamoxifen

  22. CYP2D6 and ABCC2 Genotypes Influence Response To Tamoxifen

  23. Mid CE Exam • Based on the previous slides, predict a response to tamoxifen for the following patient: • 55 y/o with Estrogen receptor negative tumors and is a CYP2D6 poor metabolizer.

  24. Breakthroughs In BCA PGx Hit The Popular Press and Scientific Literature Simultaneously

  25. Breakthroughs In BCA PGx Hit The Popular Press and Scientific Literature Simultaneously

  26. Breakthroughs In BCA PGx Hit The Popular Press and Scientific Literature Simultaneously

  27. Current Trends Summary • The rapid advances in genomics technology is being embraced and maximized in the treatment of cancers • These advances are also discovering molecular links to other disease states that are associated with cancer risks • Many drugs used in the treatment of cancers are being released with companion genetic diagnostic tests

  28. Current/Future Directions:Big Data

  29. Gene Expression Patterns Link Previously Unrelated Diseases

  30. Breast Cancer Cell Expression Patterns Link to Other Diseases

  31. Future Directions in BCA PGx

  32. Future Directions in BCA PGx

  33. Current/Future Directions:Clues From Big Data

  34. Current/Future Directions:Clues From Big Data The ACCORD Study. Simvastatin + Fenofibrate in Type 2 Diabetes

  35. Current/Future Directions:Clues From Big Data Fenofibrate Effects on Nuclear Hormone Receptor Expression in Endothelial Cells Manuscript in prep. ET Price

  36. Current/Future Directions:Clues From Big Data Fenofibrate Effects on Nuclear Hormone Receptor Expression in Endothelial Cells Manuscript in prep. ET Price

  37. Networked Analyses of Genetic Variants Will Identify Additional Cancer Risk Genes: ABCRP Pilot Proposal

  38. Current Directions in PGx-PM

  39. Current Pharma Strategies

  40. Current Pharma Strategies

  41. Current Pharma Strategies

  42. Current Pharma Strategies

  43. Current Pharma Strategies

  44. FDA Perspective On PM

  45. FDA Genomics Group of CDER

  46. Link To FDA PGX Information • http://www.fda.gov/Drugs/ScienceResearch/ResearchAreas/Pharmacogenetics/default.htm

  47. Summary

  48. Q/A

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