Pharmacogenomic management of malignancies using Integrated Clinical Genomics (ICG)

Next Generation Sequencing (NGS) technology by massively parallel sequencing significantly have reduced the cost and increased the speed of sequencing the nucleic acids from different biological sources.In 90 to 95 percent of malignancies, genetic mutations occur secondary to an environmental factors and in the remaining the mutations are due to inheritance. Variations in cancer genes (driver mutations), make them the golden aim of genome and transcriptome analysis by WGS/WES and RNA Seq in terms of integrated clinical genomics (ICG).The analysis lead to multi dimensional view of different alterations such as fusion genes that can be targeted by specific FDA approved anti-neoplastics drugs (Pharmacodynamic) so impact on the clinical decision making. In addition this data provides the required information that is related to the Pharmacokinetic of different types of drugs. Therefore pharmacogenomic management of malignancies may be facilitated significantly using ICG. Pharmacogenomics assess the role of genome on the drug response. It relates the personalized genetic features to the treatment response. This field evaluates the effect of acquired and inherited genetic variations to the drug response in patients by correlating single nucleotide variations and gene expressions to the pharmacokinetics and pharmacodynamics. The term pharmacogenomics and pharmacogenetics are often used interchangeably. However pharmacogenetics evaluates the effect of a single gene on a drug but the pharmacogenomics approach is usually genome wide and relates the effect of multiple genes on the drug response.Recently the U.S. Food and Drug Administration has approved Pembrolizumab for cancer treatment according to the particular genetic features in the first line treatment of solid malignancies. It seems FDA will gradually approve using drugs which are specific for genetic alterations independent of tumor types. Therefore in near future by decreasing the cost of NGS we hope that pharmacogenomic management using ICG to be an important part of personalized treatment of malignancies which has a potency to improve progression-free survival without enhancing the health care costs.