薬学的視点に基づいたプレシジョン・メディシンの国内基盤構築のための調査研究

抄録

Given that the cancer gene panel test was approved in June 2019, precision medicine based on the information about somatic mutation is expected to be widely available. Similarly, pharmacogenomics (PGx) associated with germline genes, such as drug-metabolizing enzymes, could also be effective tools. However, its clinical implementation has been delayed.

To address this issue, we conducted a survey regarding pharmacists’ involvement in “cancer genomic medicine (CGM)” and actual use of PGx and therapeutic drug monitoring (TDM). The response rate of the survey was 96.8％ (121/125).

According to this survey, genetic polymorphism analysis for irinotecan (UGT1A1), which is approved for genetic testing, was most commonly used. Among the tests not covered by insurance, tacrolimus (CYP3A5) and voriconazole (CYP2C19) were commonly used. Only a few facilities conducted PGx tests. Unlike PGx, many drugs are covered by insurance for TDM, which was commonly used. Vancomycin was most commonly used, followed by teicoplanin and cyclosporine. Regarding CGM, it was found that the pharmacists were most commonly involved in dose adjustment support, followed by support for selection of anti-cancer agents. Pharmacists’ participation in the expert panel was 21.3％.

This survey revealed that PGx testing is less common compared with TDM. PGx of drug-metabolizing enzymes could potentially influence adverse reactions and efficacy. It might be possible to provide individualized pharmacotherapy if PGx testing could be performed at the same time as gene panel tests. Insurance-covered PGx testing may increase in the future if more high-quality clinical trials are conducted and its usefulness is validated.