Exploring the Intersection of Pharmacogenomics and Precision Medicine in Oncology Practice and Care Team Collaboration

Pharmacy Times® interviewed Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director of Pharmacy Cancer Care at Mayo Clinic, about pharmacogenomics and precision medicine in oncology practice. He explained the differences between the terms and provided his personal experience in these areas. Soefje described how automation and technology can be significant in taking up certain responsibilities, improving efficiency while allowing for pharmacists to have more time with patients.

This interview is part of an ongoing discussion surrounding the 2024 STRIPE Annual Meeting and Consensus Workshop, which will be held October 23 to 25, in Rockville, Maryland. Coverage will be available at pharmacytimes.com.

Pharmacy Times: What is the difference between pharmacogenomics and precision medicine in terms of oncology practice and care team collaboration?

Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA: Well, cancer is the area where pharmacogenomics and precision medicine kind of overlap. But the way I see it, pharmacogenomics is the genetic changes that are affecting the drug metabolism of a drug, whereas precision medicine is: Is there a tumor driver that's driving the development of that tumor that we now have a drug that can target that pathway? Sometimes they overlap, but in more cases, we're focusing on how to get the best response for a patient in precision medicine, and pharmacogenomics is how to get the best dose for the patient of the drugs we intend to use.

Pharmacy Times: What is your experience working with specialists in pharmacogenomics or precision medicine in oncology, and how does Mayo approach collaboration among these fields?

Soefje: We actually have specialists in both areas. So, we have a precision medicine pharmacist, she's part of our precision medicine team. At Mayo Clinic, the philosophy is that the disease state experts and our clinics are all...divided down to disease states. So, we have lung cancer specialists, breast cancer specialists, prostate cancer specialists...they know the biomarkers, and they know the precision medicine markers that they need to look for in the standard of care drugs. Where our precision medicine team steps in, is what happens when they get that weird result, that result that wasn't expected from the genetic analysis, and what drugs are out there that's maybe in another disease state that could be applied to this patient successfully to help their tumor respond. So, that's how the precision medicine group works.

We also have a pharmacogenomics group that's looking at, what do we know about drug metabolism, what do we know about the genetic changes in drug metabolism, and how do we apply that to the drugs that we're using at Mayo Clinic. And cancer is just a portion of that, a portion of that process. And so, we teach all of our pharmacists to be looking for both the precision medicine and the pharmacogenomics, but we also have specialists that can help them out should it be something complex or beyond what they've ever seen.

Pharmacy Times: What is your view on the field of pharmacogenomics, and do you view this field as having a positive impact on treatment outcomes?

Soefje: I think what we're going to see in pharmacy is more automation, more technology, and so, the movement of pharmacists from that dispensing operations component [will move] into the clinic. My catch phrase is "face-to-face with patients, shoulder-to-shoulder with providers," and that's where we want the pharmacist to be. And so, a lot of the dispensing, traditional mixing, traditional operational components will be handled by technicians, maybe advanced practice techs, and then automation and technology.

The next question then becomes, where does [artificial intelligence (AI)] fit into the things like drug medication review? A large part of pharmacists' practice right now is taking the doctor's orders, reviewing it, verifying that those orders are appropriate, signing that off, and sending it off. What part of that can be done by AI? And we believe down the line, that there will be a large portion of order verification that's done by AI, and AI will flag us when it sees something out of the ordinary, and the pharmacist then will step in and look at that kind of stuff. That then frees our pharmacists up to do more of medication management.

You know, the term is "comprehensive medication management," so, we're looking at the full picture of everything that patient's taking, how is it working, are we meeting our goals, are we doing the things that we want to do? I think that's where we want pharmacists to be. We're also going to see more pharmacists doing independent practices, and when I say independent practice, I mean they'll be in the cancer center and they will see patients, and they'll be the only one that sees that patient that day. They'll review their meds, make sure everything looks good, they review the toxicities, look at the labs, everything looks good, [then] they'll refill the medication or sign [off on] the patient's meds to go off and get their chemo. And then, the practices will determine when does the pharmacist need to see them, when does the advanced practice nurse need to see them, or when does the physician need to see them. And they'll work in this team type process. It's the only way we'll survive to be able to see the number of patients that are coming down the pike with the shortages of health care personnel that we currently have.

And then cancer is just going to continue to grow. There is a tsunami of cellular products coming, and so, the products are getting more complex, more difficult to manage, all of those kinds of things, and we’re just seeing that as we go.