There are about 15 million cancer survivors in the United States; about 400,000 of them are also veterans in the Veterans Affairs (VA) system. As more people survive cancer, their medication needs go beyond their cancer treatment. For veterans, VA physicians hope to bring more personalization to cancer survivorship plans for patients with pharmacogenetic testing.
Pharmacogenetics (PGx) analyzes the inherited genetic differences in drug metabolic pathways to see how an individual may respond to drugs, both in terms of therapeutic and adverse effects. PHarmacogenomics Action for cancer SuRvivorship (PHASeR) is a new collaboration between the VA and Sanford Health Care in Sioux Falls, South Dakota, that will use PGx testing on veterans to provide preemptive testing. Deepak Voora, M.D., associate professor of medicine, will serve as director for PHASeR. This collaboration is funded entirely through a generous donation from Denny Sanford.
The initial pilot study will start at the Durham VA and will expand to about 40 sites and 50,000 patients in the first two years. Over the following three years, the project will expand to include over 100 sites and up to 250,000 patients.
Participants enrolled in PHASeR will complete a simple blood panel that will test eight genes that handle metabolism and transport of commonly prescribed medications for mental health, pain and cardiometabolic diseases. “Each person has a different makeup of genetic differences within those genes,” Voora said. By analyzing a patient’s genes, physicians can see how certain medicines will interact with that patient, allowing them to make better informed decisions on the amount of the medication to prescribe or if a different medication would be more appropriate.
Deepak Voora provides an overview of PHASeR at the National Press Club in Washington, D.C.
This testing is preemptive, which means a patient may not need any medication at the time of testing. Instead, this test will provide helpful information to include in their electronic health records, so should the need arise in the future, this information will be readily available to their healthcare professionals. “When physicians order specific medications,” Voora said, “this system would be working in the background to check patients’ genetic profiles and alert physicians to any issues.”
Initally, PHASeR participants will be military veteran cancer survivors. Cancer survivors are at a greater risk of chronic mental health issues, metabolic disease and chronic pain. Using PGx testing could help reduce medication side effects, maximize medication benefits and reduce opioid exposure by using a patient’s genetic makeup to ensure the right dose of the right drug. Over time, the program will be expanded to other veteran patients.
This should take some of the guesswork out of prescribing drugs to patients. Currently, there is some trial and error in figuring out the best medication for patients. For example, a patient being treated with depression may have to try several different drugs before finding the one that helps the most. Since it takes four to six weeks to cycle through each drug to test its efficacy, a patient could continue to struggle with depression for months before finding relief. By using PGx testing, a healthcare provider could find the best drug with the fewest side effects for each individual patient faster, which, in turn, will create better outcomes, satisfaction and drug adherence for the patients.
This project kicked off on Tuesday, March 12 with a press conference in Washington D.C. with Secretary of the VA Robert Wilkie, CEO of Sanford Health Kelby Krabbenhoft, Voora, Denny, National Program Director for Oncology and Duke Medical Oncologist Michael Kelley, and members of Sanford Health.
A second media event took place on Friday, March 15 at the Durham VA to kick off the study. Voora, Kelley, members from Sanford Health and a veteran will speak with the local media about the study.
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