{"id":65367,"date":"2022-10-05T15:46:38","date_gmt":"2022-10-05T21:46:38","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=65367"},"modified":"2022-10-31T15:32:39","modified_gmt":"2022-10-31T21:32:39","slug":"genetics-help-predict-severe-drug-reactions","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/genetics-help-predict-severe-drug-reactions\/","title":{"rendered":"Genetics can help to predict bad reactions to chemotherapy and other drugs"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><p>&nbsp;<\/p>\n<figure id=\"attachment_65737\" aria-describedby=\"caption-attachment-65737\" style=\"width: 640px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-65737\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/09\/14154231\/web_Geneticpharmacology.webp\" alt=\"a photo of genetics, which can be used to predict drug reactions.\" width=\"640\" height=\"360\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/09\/14154231\/web_Geneticpharmacology.webp 800w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/09\/14154231\/web_Geneticpharmacology-300x169.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/09\/14154231\/web_Geneticpharmacology-768x432.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/09\/14154231\/web_Geneticpharmacology-150x84.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/09\/14154231\/web_Geneticpharmacology-200x113.webp 200w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><figcaption id=\"caption-attachment-65737\" class=\"wp-caption-text\">The Biobank at the Colorado Center of Personalized Medicine, a partnership between UCHealth and the University of Colorado Anschutz Medical Campus, is helping patients avoid adverse reactions to medications \u2013 most recently, those that fight cancer. Photo: Getty Images<\/figcaption><\/figure>\n<p>The <a href=\"https:\/\/www.uchealth.org\/today\/biobanking-makes-genetics-fundamental-part-of-health-care\/\">Biobank<\/a> at the Colorado Center for Personalized Medicine is now helping chemotherapy patients avoid a bitter pill.<\/p>\n<p>Since June, the joint University of Colorado Anschutz Medical Campus-UCHealth repository for genetic information has provided data on a particular gene \u2013 DPYD \u2013 to the UCHealth electronic health record. The addition won\u2019t make a difference for most of the 90,000 (and counting) UCHealth patients who have submitted blood samples to the biobank for DNA analyis. But for some, their survival could hinge on it.<\/p>\n<figure id=\"attachment_65369\" aria-describedby=\"caption-attachment-65369\" style=\"width: 200px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-65369 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/08\/23102351\/Christopher-Lieu.webp\" alt=\"Dr. Christopher Lieu, a UCHealth and CU School of Medicine oncologist, who know uses genetics to help predict his patient's reactions to certain drugs.\" width=\"200\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/08\/23102351\/Christopher-Lieu.webp 600w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/08\/23102351\/Christopher-Lieu-200x300.webp 200w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/08\/23102351\/Christopher-Lieu-100x150.webp 100w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><figcaption id=\"caption-attachment-65369\" class=\"wp-caption-text\">Dr. Christopher Lieu<\/figcaption><\/figure>\n<p>The DPYD gene helps regulate how the body clears two widely used chemotherapy drugs: 5-fluorouracil and capecitabine. About 1,500 UCHealth patients received one of these drugs last year, said <a id=\"\" href=\"https:\/\/pharmacy.cuanschutz.edu\/about-us\/profile\/christina-aquilante\" target=\"_blank\" rel=\"noopener\">Christina Aquilante<\/a>, a CU Skaggs School of Pharmacy professor and director of pharmacogenomics at the Colorado Center for Personalized Medicine. \u201cThese drugs are a backbone treatment for a lot of malignancies \u2013 colorectal, pancreatic, and breast cancer among them,\u201d she said.<\/p>\n<p>But those with a faulty DPYD gene may have severe and even deadly reactions to the chemotherapy. Despite this, the genetic testing required to spot a DPYD-gene problem isn\u2019t usually done. That\u2019s changing at UCHealth.<\/p>\n<h2><strong>Red flag warning: abnormal DPYD gene<\/strong><\/h2>\n<p><a href=\"https:\/\/www.uchealth.org\/provider\/christopher-lieu-md-cancer-oncology\/\">Dr. Christopher Lieu<\/a>, a UCHealth and CU School of Medicine oncologist, got the first alert identifying a patient with an abnormal DPYD gene. The patient had already received a fluorouracil and had then suffered extreme side effects including mouth sores, diarrhea, and low white blood cell counts. The alert came too late for that round \u2013 the treatment had preceded the DPYD rollout \u2013 but it helped both Lieu and the patient understand why the reaction had been so bad. It also helped Lieu plan the best postsurgical chemotherapy regimen.<\/p>\n<p>\u201cThe information explained to me why they were having the problems they were having,\u201d Lieu said.<\/p>\n<p>The next patient the biobank flags with a DPYD variant will benefit beforehand, he added.<\/p>\n<p>\u201cI think this can be incredibly helpful in terms of knowing who might have a severe reaction to chemotherapy,\u201d he said. \u201cAnd that helps me as a doctor in knowing where it might be dangerous to give a particular chemotherapy.\u201d<\/p>\n<p>With such foreknowledge, oncologists such as Lieu can go with lower doses or choose alternative chemotherapies. Doing so can not only minimize patient pain but also avoid delays in care that false starts with ill-matched chemotherapies can trigger.<\/p>\n<figure id=\"attachment_65370\" aria-describedby=\"caption-attachment-65370\" style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-65370\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/08\/23102442\/christina-aquilante.webp\" alt=\"Christina Aquilante, a CU Skaggs School of Pharmacy professor and director of pharmacogenomics at the Colorado Center for Personalized Medicine, who looks at genetics and drug reactions.\" width=\"300\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/08\/23102442\/christina-aquilante.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/08\/23102442\/christina-aquilante-150x150.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/08\/23102442\/christina-aquilante-200x200.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-65370\" class=\"wp-caption-text\">Christina Aquilante<\/figcaption><\/figure>\n<p>\u201cThe longer you have cancer, the more likely it is to progress and even spread. If you\u2019re messing around with different chemo regimens, from first-line to second-line to third-line, the greater the chances of not finishing a course that will slow the disease down,\u201d said <a href=\"https:\/\/www.uchealth.org\/provider\/david-kao-md\/\">Dr. David Kao<\/a>, a UCHealth and Colorado School of Medicine cardiologist who serves as medical director of the Colorado Center for Personalized Medicine. \u201cSlowing chemotherapy down is counterproductive.\u201d<\/p>\n<h2><strong>Genetics and drug reactions: more than chemo<\/strong><\/h2>\n<p>Avoiding statins when high cholesterol can starkly elevate heart-attack risk is also counterproductive. But it happens often, Kao says, because of genetic traits that cause statins to trigger muscle pain in some patients.<\/p>\n<p>With other drug interactions, the threat is more imminent.<\/p>\n<p>\u201cThere are certain genes where the side effect is death,\u201d Kao said. \u201cFor those situations, it is critical to identify at-risk patients even if the abnormal gene is relatively rare, as in the case of DPYD.\u201d<\/p>\n<p>Thanks to pharmacogenetic input from the biobank, physicians can choose different statins or cut the dosage, he says.<\/p>\n<p>So far, the Colorado Center for Personalized Medicine has processes in place to alert doctors of possible patient-drug interactions related to three pharmacogenetic genes: DPYD, SLCO1B1, and CYP2C19, Aquilante says. Those genes affect the metabolism of some 20 medications. They include a range of widely-prescribed medications including statins such as Lipitor and Crestor, antiplatelet medications such as Plavix, proton-pump inhibitors such as Prilosec, and antidepressants like Lexapro and Celexa, she adds.<\/p>\n<h2><strong>Expanding knowledge of pharmacogenetic genes, other genetic variants<\/strong><\/h2>\n<p>More pharmacogenetic alerts are on the way, Kao says. Researchers have identified a <a id=\"\" href=\"https:\/\/www.fda.gov\/medical-devices\/precision-medicine\/table-pharmacogenetic-associations\" target=\"_blank\" rel=\"noopener\">growing list<\/a> of pharmacogenetic genes, and it looks like the <a id=\"\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6563578\/#:~:text=Recent%20large%2Dscale%20genotyping%20and,and%20would%20be%20deemed%20actionable.\" target=\"_blank\" rel=\"noopener\">vast majority<\/a> of people harbor variations in these genes that may affect how we process particular drugs. The biobank is expanding its portfolio of genomic-testing platforms as well as working on the breadth, quality, and timing of information provided to providers and patients, he says.<\/p>\n<figure id=\"attachment_62170\" aria-describedby=\"caption-attachment-62170\" style=\"width: 230px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-62170 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/01\/31093946\/Dr.-David-Kao.webp\" alt=\"Dr. David Kao, a UCHealth and Colorado School of Medicine cardiologist who serves as medical director of the Colorado Center for Personalized Medicine, who looks at genetics and drug reactions.\" width=\"230\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/01\/31093946\/Dr.-David-Kao.webp 290w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/01\/31093946\/Dr.-David-Kao-230x300.webp 230w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/01\/31093946\/Dr.-David-Kao-115x150.webp 115w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/01\/31093946\/Dr.-David-Kao-200x261.webp 200w\" sizes=\"auto, (max-width: 230px) 100vw, 230px\" \/><figcaption id=\"caption-attachment-62170\" class=\"wp-caption-text\">Dr. David Kao<\/figcaption><\/figure>\n<p>The biobank\u2019s mandate of bringing personalized or precision medicine into medical care based on patients\u2019 genetic makeup extends well beyond pharmacogenetics. Analyses are being used to identify genetic variants with &#8220;significant health implications&#8221; that place a patient at risk for health conditions, including certain types of cancer and heart disease, for which early intervention can make a difference.<\/p>\n<p>&#8220;Today, we are looking for this type of genetic variation in 78 different genes,&#8221; said Kristy Crooks, a UCHealth and CU School of Medicine clinical molecular and cytogeneticist who serves as director of the Colorado Center for Personalized Medicine biobank. &#8220;Returning these genetic test results to patients who have consented to receive this information ensures that biobank participants can work with their health care providers to reduce their health risks.&#8221;<\/p>\n<p>You can <a href=\"https:\/\/mychart.uchealth.org\/MyChart\/Authentication\/Login?postloginurl=inside%2Easp%3Fmode%3Dshowform%26formname%3DzuchResearchOpportunities%26mobileaction%3Dhttps%253A%252F%252Fexit%2Euchealth%2Eorg%252Fresearchopportunities\">sign up for the biobank<\/a>. Once you sign in, you will view a video and link to a consent form.<\/p>\n<p>With growing pharmacogenetics capabilities and much more, the medical community\u2019s longstanding aspirations of providing tailored medical treatment down to the molecular level are being realized today.<\/p>\n<p>\u201cEveryone says, \u2018It\u2019s the future of medicine,\u2019\u201d Aquilante said. \u201cWell, it\u2019s happening now at UCHealth. It\u2019s happening with the biobank. It\u2019s not science fiction. It\u2019s helping people in really important ways.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; The Biobank at the Colorado Center for Personalized Medicine is now helping chemotherapy patients avoid a bitter pill. Since June, the joint University of Colorado Anschutz Medical Campus-UCHealth repository for genetic information has provided data on a particular gene \u2013 DPYD \u2013 to the UCHealth electronic health record. The addition won\u2019t make a difference [&hellip;]<\/p>\n","protected":false},"author":23,"featured_media":65737,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[9085,28,9104],"class_list":["post-65367","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-biobank","tag-cancer-care-oncology","tag-colorado-center-for-personalized-medicine"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.7 (Yoast SEO v27.7) - 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