Is Pharmacogenomics For Real?
So maybe the crowd (such as it is) can help me with this one. I’ve been racking my brain and scouring Google to come up with some good examples - hell, any examples - of pharmacogenomics in practice, right now. I mean, this is the supposed Holy Grail of personalized medicine - that drugs will be tailored to our genomes - and there has been a good 20 years research. But I can only find two examples: Herceptin, which is used in breast cancer patients whose cancer is caused by excessive protein from the HER2 gene; and warfarin, a blood-thinning drug used for patients recovering from heart attack or major surgery - there’s now a screening test for those with certain gene that causes excess bleeding, raising the possibility of serious side effects (stroke, etc).
But really, that’s it? I mean it’s 2007, and this is the big payoff of personalized medicine, which we’ve been hearing about for a decade - two lousy drugs?
Tell me if I’m wrong (I sure hope I am…)
October 2nd, 2007 at 11:13 pm
There are plenty of other examples. I’ll dedicate a whole post to this subject. Just some of them: CYP450’s role in the metabolization of about 45% of all the drugs we know; CYP2D6’s role in metabolizing painkillers containing codein.
I’ll let you know when my post is ready.
October 3rd, 2007 at 12:25 am
Berci,
Thomas is asking which specific drugs have genetic tests that are used to determine dosages as a clinical standard. Those two are the only FDA sanctioned ones I know of and even warfarin genetic testing has some doctors up in arms.
Upcoming is one for Celexa that looks at two genetic markers–GRIK2 and GRIA3– that appear to increase the risk of suicidal thoughts in people taking the drug. NeuroMark will begin selling the test tomorrow. I don’t believe it’s recommended by the FDA, though.
October 3rd, 2007 at 5:36 am
Given the duration of clinical trials and how recent pharmacogenomics is (some pharma are just getting in), the better question might be to check how many drugs in trials have a strong pharmacogenomic basis.
October 3rd, 2007 at 8:29 am
Just expanding that thought
1. Agendia and Genomics Health have prognostic tests for Breast Cancer, both of which would be examples of pharmacogenomics
2. Tarceva, Iressa, Erbutix can all be administered based on EGFR expression (Tarceva has a companion diagnostic)
3. Pfizer’s newly approved anti-HIV drug (Selzentry)
Also, a lot of PGx is showing up in how clinical trials are being conducted and not just in the availability of companion diagnostics.
I’d like to add that while PGx is getting more commonly used, there is a lot of work required in validating biomarkers, and probably the main reason why it’s taking a while for more tests to show up. It’s a multi year process. I suspect we will really only start seeing a rush of PGx drugs only by the end of the decade
October 3rd, 2007 at 9:02 pm
[…] Goetz asks, Is pharmacogenomics for real?. I left a long comment with the post, so I won’t repeat myself here, but I did want to add a […]