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Reizine N, Vokes EE, Liu P, Truong TM, Nanda R, Fleming GF, Catenacci DV, Pearson AT, Parsad S, Danahey K, van Wijk XMR, Yeo KTJ, Ratain MJ, O’Donnell PH. Implementation of pharmacogenomic testing in oncology care (PhOCus): study protocol of a pragmatic, randomized clinical trial. Ther Adv Med Oncol 2020; 12:1758835920974118. [PMID: 33414846 PMCID: PMC7750903 DOI: 10.1177/1758835920974118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many cancer patients who receive chemotherapy experience adverse drug effects. Pharmacogenomics (PGx) has promise to personalize chemotherapy drug dosing to maximize efficacy and safety. Fluoropyrimidines and irinotecan have well-known germline PGx associations. At our institution, we have delivered PGx clinical decision support (CDS) based on preemptively obtained genotyping results for a large number of non-oncology medications since 2012, but have not previously evaluated the utility of this strategy for patients initiating anti-cancer regimens. We hypothesize that providing oncologists with preemptive germline PGx information along with CDS will enable individualized dosing decisions and result in improved patient outcomes. METHODS Patients with oncologic malignancies for whom fluoropyrimidine and/or irinotecan-inclusive therapy is being planned will be enrolled and randomly assigned to PGx and control arms. Patients will be genotyped in a clinical laboratory across panels that include actionable variants in UGT1A1 and DPYD. For PGx arm patients, treating providers will be given access to the patient-specific PGx results with CDS prior to treatment initiation. In the control arm, genotyping will be deferred, and dosing will occur as per usual care. Co-primary endpoints are dose intensity deviation rate (the proportion of patients receiving dose modifications during the first treatment cycle), and grade ⩾3 treatment-related toxicities throughout the treatment course. Additional study endpoints will include cumulative drug dose intensity, progression-free survival, dosing of additional PGx supportive medications, and patient-reported quality of life and understanding of PGx. DISCUSSION Providing a platform of integrated germline PGx information may promote personalized chemotherapy dosing decisions and establish a new model of care to optimize oncology treatment planning.
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Affiliation(s)
- Natalie Reizine
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center and Biological Sciences, Chicago, IL, USA
- Center for Personalized Therapeutics, University of Chicago, Chicago, IL, USA
| | - Everett E. Vokes
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center and Biological Sciences, Chicago, IL, USA
| | - Ping Liu
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Tien M. Truong
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center and Biological Sciences, Chicago, IL, USA
- Center for Personalized Therapeutics, University of Chicago, Chicago, IL, USA
| | - Rita Nanda
- Department of Pharmacy, University of Chicago Medical Center, Chicago, IL, USA
| | - Gini F. Fleming
- Department of Pharmacy, University of Chicago Medical Center, Chicago, IL, USA
| | | | | | - Sandeep Parsad
- Department of Pharmacy, University of Chicago Medical Center, Chicago, IL, USA
| | - Keith Danahey
- Center for Personalized Therapeutics, University of Chicago, Chicago, IL, USA Center for Research Informatics, University of Chicago, Chicago, IL, USA
| | - Xander M. R. van Wijk
- Center for Personalized Therapeutics, University of Chicago, Chicago, IL, USA Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, IL, USA
| | - Kiang-Teck J. Yeo
- Center for Personalized Therapeutics, University of Chicago, Chicago, IL, USA Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, IL, USA
| | - Mark J. Ratain
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center and Biological Sciences, Chicago, IL, USA Center for Personalized Therapeutics, University of Chicago, Chicago, IL, USA
| | - Peter H. O’Donnell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center and Biological Sciences, Chicago, 5841 S. Maryland Avenue, MC2115, Chicago, IL 60637, USA
- Center for Personalized Therapeutics, University of Chicago, 5841 S. Maryland Avenue, MC2115, Chicago, IL 60637, USA
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Mathur P, Srivastava S, Xu X, Mehta JL. Artificial Intelligence, Machine Learning, and Cardiovascular Disease. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2020; 14:1179546820927404. [PMID: 32952403 PMCID: PMC7485162 DOI: 10.1177/1179546820927404] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
Artificial intelligence (AI)-based applications have found widespread
applications in many fields of science, technology, and medicine. The use of
enhanced computing power of machines in clinical medicine and diagnostics has
been under exploration since the 1960s. More recently, with the advent of
advances in computing, algorithms enabling machine learning, especially deep
learning networks that mimic the human brain in function, there has been renewed
interest to use them in clinical medicine. In cardiovascular medicine, AI-based
systems have found new applications in cardiovascular imaging, cardiovascular
risk prediction, and newer drug targets. This article aims to describe different
AI applications including machine learning and deep learning and their
applications in cardiovascular medicine. AI-based applications have enhanced our
understanding of different phenotypes of heart failure and congenital heart
disease. These applications have led to newer treatment strategies for different
types of cardiovascular diseases, newer approach to cardiovascular drug therapy
and postmarketing survey of prescription drugs. However, there are several
challenges in the clinical use of AI-based applications and interpretation of
the results including data privacy, poorly selected/outdated data, selection
bias, and unintentional continuance of historical biases/stereotypes in the data
which can lead to erroneous conclusions. Still, AI is a transformative
technology and has immense potential in health care.
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Affiliation(s)
- Pankaj Mathur
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Shweta Srivastava
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Xiaowei Xu
- Department of Information Science, University of Arkansas at Little Rock, Little Rock, AR USA
| | - Jawahar L Mehta
- Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Langaee T, El Rouby N, Stauffer L, Galloway C, Cavallari LH. Development and Cross-Validation of High-Resolution Melting Analysis-Based Cardiovascular Pharmacogenetics Genotyping Panel. Genet Test Mol Biomarkers 2019; 23:209-214. [DOI: 10.1089/gtmb.2018.0298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Taimour Langaee
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Nihal El Rouby
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Lynda Stauffer
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Cheryl Galloway
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida
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Kalinin AA, Higgins GA, Reamaroon N, Soroushmehr S, Allyn-Feuer A, Dinov ID, Najarian K, Athey BD. Deep learning in pharmacogenomics: from gene regulation to patient stratification. Pharmacogenomics 2018; 19:629-650. [PMID: 29697304 PMCID: PMC6022084 DOI: 10.2217/pgs-2018-0008] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/09/2018] [Indexed: 01/02/2023] Open
Abstract
This Perspective provides examples of current and future applications of deep learning in pharmacogenomics, including: identification of novel regulatory variants located in noncoding domains of the genome and their function as applied to pharmacoepigenomics; patient stratification from medical records; and the mechanistic prediction of drug response, targets and their interactions. Deep learning encapsulates a family of machine learning algorithms that has transformed many important subfields of artificial intelligence over the last decade, and has demonstrated breakthrough performance improvements on a wide range of tasks in biomedicine. We anticipate that in the future, deep learning will be widely used to predict personalized drug response and optimize medication selection and dosing, using knowledge extracted from large and complex molecular, epidemiological, clinical and demographic datasets.
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Affiliation(s)
- Alexandr A Kalinin
- Department of Computational Medicine & Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Statistics Online Computational Resource (SOCR), University of Michigan School of Nursing, Ann Arbor, MI 48109, USA
| | - Gerald A Higgins
- Department of Computational Medicine & Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Narathip Reamaroon
- Department of Computational Medicine & Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Sayedmohammadreza Soroushmehr
- Department of Computational Medicine & Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Ari Allyn-Feuer
- Department of Computational Medicine & Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Ivo D Dinov
- Department of Computational Medicine & Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Statistics Online Computational Resource (SOCR), University of Michigan School of Nursing, Ann Arbor, MI 48109, USA
- Michigan Institute for Data Science (MIDAS), University of Michigan, Ann Arbor, MI 48109, USA
| | - Kayvan Najarian
- Department of Computational Medicine & Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Brian D Athey
- Department of Computational Medicine & Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Michigan Institute for Data Science (MIDAS), University of Michigan, Ann Arbor, MI 48109, USA
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Mills RA, Eichmeyer JN, Williams LM, Muskett JA, Schmidlen TJ, Maloney KA, Lemke AA. Patient Care Situations Benefiting from Pharmacogenomic Testing. CURRENT GENETIC MEDICINE REPORTS 2018. [DOI: 10.1007/s40142-018-0136-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Dunnenberger HM, Biszewski M, Bell GC, Sereika A, May H, Johnson SG, Hulick PJ, Khandekar J. Implementation of a multidisciplinary pharmacogenomics clinic in a community health system. Am J Health Syst Pharm 2018; 73:1956-1966. [PMID: 27864203 DOI: 10.2146/ajhp160072] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The development and implementation of a multidisciplinary pharmacogenomics clinic within the framework of an established community-based medical genetics program are described. SUMMARY Pharmacogenomics is an important component of precision medicine that holds considerable promise for pharmacotherapy optimization. As part of the development of a health system-wide integrated pharmacogenomics program, in early 2015 Northshore University Health-System established a pharmacogenomics clinic run by a multidisciplinary team including a medical geneticist, a pharmacist, a nurse practitioner, and genetic counselors. The team identified five key program elements: (1) a billable-service provider, (2) a process for documentation of relevant medication and family histories, (3) personnel with the knowledge required to interpret pharmacogenomic results, (4) personnel to discuss risks, benefits, and limitations of pharmacogenomic testing, and (5) a mechanism for reporting results. The most important program component is expert interpretation of genetic test results to provide clinically useful information; pharmacists are well positioned to provide that expertise. At the Northshore University HealthSystem pharmacogenomics clinic, patient encounters typically entail two one-hour visits and follow a standardized workflow. At the first visit, pharmacogenomics-focused medication and family histories are obtained, risks and benefits of genetic testing are explained, and a test sample is collected; at the second visit, test results are provided along with evidence-based pharmacotherapy recommendations. CONCLUSION A multidisciplinary clinic providing genotyping and related services can facilitate the integration of pharmacogenomics into clinical care and meet the needs of early adopters of precision medicine.
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Affiliation(s)
- Henry M Dunnenberger
- Center for Molecular Medicine, NorthShore University HealthSystem, Evanston, IL.
| | - Matthew Biszewski
- Thrombosis and Anticoagulation Unit, NorthShore University HealthSystem, Glenview, IL
| | | | - Annette Sereika
- Center for Molecular Medicine, NorthShore University HealthSystem, Evanston, IL
| | - Holley May
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL
| | | | - Peter J Hulick
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL
| | - Janardan Khandekar
- Center for Molecular Medicine, NorthShore University HealthSystem, Evanston, IL
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Caraballo PJ, Bielinski SJ, St. Sauver JL, Weinshilboum RM. Electronic Medical Record-Integrated Pharmacogenomics and Related Clinical Decision Support Concepts. Clin Pharmacol Ther 2017; 102:254-264. [DOI: 10.1002/cpt.707] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 12/22/2022]
Affiliation(s)
- PJ Caraballo
- Division of General Internal Medicine; Department of Medicine, Mayo Clinic; Rochester Minnesota USA
- Office of Information and Knowledge Management; Mayo Clinic; Rochester Minnesota USA
| | - SJ Bielinski
- Division of Epidemiology; Department of Health Sciences Research, Mayo Clinic; Rochester Minnesota USA
| | - JL St. Sauver
- Division of Epidemiology; Department of Health Sciences Research, Mayo Clinic; Rochester Minnesota USA
- Center for the Science of Health Care Delivery; Mayo Clinic; Rochester Minnesota USA
| | - RM Weinshilboum
- Division of Clinical Pharmacology; Departments of Molecular Pharmacology and Experimental Therapeutics & Medicine, Mayo Clinic; Rochester Minnesota USA
- Center for Individualized Medicine; Mayo Clinic; Rochester Minnesota USA
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