Pharmacogenetics is typically defined as inherited genetic differences that influence an individual’s response to a medication. Seminal work performed by 2017 Paul F. Parker Medal recipient Dr. William Evans and his long-time collaborator, Dr. Mary Relling, identified genetic polymorphisms in thiopurine methyltransferase (TPMT) as the primary determinant of excessive toxicity in pediatric patients receiving mercaptopurine and demonstrated that standard dose reductions reduce adverse effects without compromising outcomes.¹ This work led to FDA label changes for mercaptopurine and routine incorporation of testing for TPMT polymorphisms into clinical practice.

Precision medicine (PM), the most recent evolution in genomic medicine, is an emerging approach for disease treatment and prevention that considers individual variability in genes, environment, and lifestyle. The Precision Medicine Initiative (PMI) was launched by President Barack Obama in his State of the Union Address in January 2015. Subsequently, federal legislation allocated $200 million for the PMI and the 21st Century Cures Act. The proposed initiative has two main components. Initially, the focus will be on cancer, with increased funding for PM clinical trials, drug resistance studies, development of new cancer models, and creation of a national database. Ultimately, the goal is to apply PM to a range of human health concerns and diseases by establishing a research cohort of 1 million Americans, who will share their health data, provide biospecimens, and give permission to be re-contacted in the future. PM includes not only disease prevention and diagnosis but treatment as well, making precision pharmacotherapy an important component of PM.

ACCP members are already leaders in the science, practice, and implementation of precision pharmacotherapy. For an excellent overview of PM and the initiatives led by ACCP members, please see the September 2017 PM-themed issue of Pharmacotherapy. This issue contains important therapeutic reviews of PM’s impact in cancer, opioid use, diabetes, dyslipidemia, and anticoagulation. The issue also contains original research by ACCP members investigating the impact of pharmacogenomic markers on cognitive function in schizophrenia, tacrolimus dosing in kidney transplant patients, and heparin-induced thrombocytopenia. Several articles discuss practical considerations in implementing PM, including collaborative counseling, clinical trial designs, level of evidence in clinical decision-making, and guidance on selecting a reference laboratory.

Consistent with its new strategic plan, ACCP aims to provide opportunities for developing knowledge and skills in PM that advance clinical practice, education, and research. Led by Kelly Caudle, the Pharmacokinetics/Pharmacodynamics/Pharmacogenomics Practice and Research Network is writing an opinion paper to address the question, “What is precision pharmacotherapy?” The ACCP Clinical Practice Affairs Committee, led by Kevin Hicks and Christina Aquilante, has been charged to develop a complementary ACCP white paper that articulates real-world clinical applications of PM (specifically, “precision pharmacotherapy”) to today’s clinical pharmacist’s practice. Finally, a Blue Ribbon Task Force, led by Vicki Ellingrod, will provide recommendations on how ACCP can advance knowledge and skill development in precision pharmacotherapy, including advice and guidance on how ACCP might establish traineeships in the field.

I would like to thank the members currently working on these important initiatives and invite all members to contact me at [email protected] with additional thoughts, suggestions, or plans for incorporating precision pharmacotherapy into their research, teaching, and practice. Together, we can learn from ACCP members who are already leading important precision pharmacotherapy initiatives and position the College as the leader in supporting precision pharmacotherapy research and implementation.

Reference

1. Relling MV, Hancock ML, Rivera GK, et al. Mercaptopurine therapy intolerance and heterozygosity at the thiopurine S-methyltransferase gene locus. J Natl Cancer Inst 1999;91:2001-8.