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    Precision Medicine: A New Role for Pharmacists

    The biggest innovation in medicine in the last decade (and how to get in on it).

    Precision medicines are undergoing a rapid period of growth and acceptance within the health-care arena, according to a report from Stockholm-based QuintilesIMS Institute. Pharmacists can play a vital role in ensuring that these medicines are used effectively.

    Precision medicines are defined as treatments that are tailored to groups of patients based on specific biomarkers or to individuals based on their genetic profile or status, according to the QuintilesIMS report. “There are around 80 precision medicines currently on the market, with more than half in the field of cancer treatment,” said Murray Aitken, Executive Director of the Institute and co-author of the report. “In the past five years, we’ve seen a surge in new precision medicines—and in spending on them—and there are more in the pipeline.”

    Related article: Where's the infrastructure for precision medicine?

    “The dramatic decrease in the cost and time it takes to perform genomic sequencing has contributed significantly to the development of precision medicines,” Aitken told Drug Topics. “Another contributing factor is the understanding that the ‘one-size-fits-all’ approach to medicine is costly, as many patients will not respond to first-line therapies and will receive care that is not beneficial. Development of precision medicines that get the right dose to the right patient at the right time has the potential to provide savings,” he said.

    “Precision medicine represents one of the biggest innovations in medicine over the last decade,” said Ali McBride, PharmD, MS, BCPS, BCOP, Clinical Coordinator, Hematology/Oncology, University of Arizona Cancer Center in Tucson. “The paradigm is changing from the classic diagnostic test with a disease-state diagnosis to a genetic-based diagnosis.” 

    Off-Label Use

    Many of the drugs used as part of this new paradigm are approved drugs that are being used for an off-label use, McBride told Drug Topics. While the majority of these agents are applied to the oncology areas, there have also been advances in rheumatology and cardiovascular disease, he said.

    The science is best exemplified for anticancer drugs, said Meindert Danhof, PharmD, Director of Research, Leiden University, the Netherlands. Larotrectinib, for example, is a drug that targets a mutation in the tropomyosin receptor kinase (TRK) gene. “Originally this mutation was discovered in patients with colon carcinoma. It now appears that this mutation occurs in 0.5% of all cancers. So the genetic testing yields the basis for the selection of the drug, rather than the anatomical location of the tumor.”

    Related article: A First: Cancer Drug Is Approved on Genetic Basis, Not Tumor Location

    While the science is advancing rapidly, there are challenges, Aitken said. “Health systems will need to adapt to the increasing complexity associated with these agents, from timely and accurate diagnostic testing, though multifaceted supply and delivery chains, to complex protocols, and patient pharmacovigilance,” he said.

    “Intricate and evolving protocols are a challenge to health-care systems,” Aitken continued. “Protocols for precision medicine need to be constantly updated to keep up with scientific breakthroughs. This can be a complicated procedure with multiple stakeholders involved.”

    Up next: Not just health-system pharmacy

    Kathleen Gannon Longo
    Kathleen Gannon Longo is a Contributing Editor.

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