Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina, USA
NorthShore University Health System, Evanston, Illinois, USA.
Oncologist. 2018 Aug;23(8):956-964. doi: 10.1634/theoncologist.2017-0599. Epub 2018 Apr 5.
Genomic medicine provides opportunities to personalize cancer therapy for an individual patient. Although novel targeted therapies prolong survival, most patients with cancer continue to suffer from burdensome symptoms including pain, depression, neuropathy, nausea and vomiting, and infections, which significantly impair quality of life. Suboptimal management of these symptoms can negatively affect response to cancer treatment and overall prognosis. The effect of genetic variation on drug response-otherwise known as pharmacogenomics-is well documented and directly influences an individual patient's response to antiemetics, opioids, neuromodulators, antidepressants, antifungals, and more. The growing body of pharmacogenomic data can now guide clinicians to select the safest and most effective supportive medications for an individual patient with cancer from the very first prescription. This review outlines a theoretical patient case and the implications of using pharmacogenetic test results to personalize supportive care throughout the cancer care continuum.
Integration of palliative medicine into the cancer care continuum has resulted in increased quality of life and survival for patients with many cancer types. However, suboptimal management of symptoms such as pain, neuropathy, depression, and nausea and vomiting continues to place a heavy burden on patients with cancer. As demonstrated in this theoretical case, pharmacogenomics can have a major effect on clinical response to medications used to treat these conditions. Recognizing the value of supportive care pharmacogenomics in oncology and application into routine practice offers an objective choice for the safest and most effective treatment compared with the traditional trial and error method.
基因组医学为个体患者提供了癌症治疗的个体化机会。尽管新型靶向治疗可延长生存时间，但大多数癌症患者仍继续遭受包括疼痛、抑郁、神经病变、恶心和呕吐以及感染在内的负担性症状的困扰，这些症状严重影响了生活质量。这些症状的管理不善可能会对癌症治疗的反应和整体预后产生负面影响。遗传变异对药物反应的影响（又称药物基因组学）已有充分记录，直接影响个体患者对抗恶心药物、阿片类药物、神经调节剂、抗抑郁药、抗真菌药等的反应。越来越多的药物基因组学数据现在可以指导临床医生在为癌症患者开具第一份处方时，从众多安全有效的支持性药物中为个体患者选择最合适的药物。本文概述了一个理论患者病例，并说明了在癌症治疗全过程中使用药物遗传学检测结果来实现支持性护理个体化的意义。
姑息医学与癌症护理的融合已经使许多癌症患者的生活质量和生存率得到了提高。然而，疼痛、神经病变、抑郁和恶心、呕吐等症状的管理不善仍然给癌症患者带来沉重负担。正如这个理论案例所证明的，药物基因组学可以对用于治疗这些疾病的药物的临床反应产生重大影响。认识到肿瘤学中支持性护理药物基因组学的价值并将其应用于常规实践，与传统的反复试验方法相比，为最安全、最有效的治疗提供了客观选择。
