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Aim: To evaluate the potential impact of preemptive multigene pharmacogenomic (PGx) testing on medication prescribing in real-world clinical settings. Patients & methods: Prescription frequencies for 65 medications with actionable PGx recommendations were collected in 215 percutaneous coronary intervention (PCI) and 131 allogeneic hematopoietic cell transplant (allo-HCT) patients. A simulation projected the number of PGx-guided prescribing opportunities. Results: In PCI and allo-HCT patients, respectively, 66.5 and 90.1% were prescribed at least one medication with actionable PGx prescribing recommendations. Simulations projected 26.5 and 41.2 total PGx-guided prescribing opportunities per 100 PCI and allo-HCT patients, respectively, if multigene PGx results were available. Conclusion: A multigene PGx testing strategy offers potential to optimize medication prescribing beyond clopidogrel and tacrolimus in PCI and allo-HCT patients.

OBJECTIVE To describe the proposed mechanisms of chemotherapy-associated cardiomyopathy (CAC) and potential cardioprotective therapies for CAC including a comprehensive review of existing systematic analyses, guideline recommendations, and ongoing clinical trials. DATA SOURCES A literature search of MEDLINE was performed (from 1990 to June 2020) using the following search terms: anthracycline, trastuzumab, cardiomyopathy, cardiotoxicity, primary prevention, angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), beta blocker, dexrazoxane (DEX) as well as using individual names from select therapeutic categories. STUDY SELECTION AND DATA EXTRACTION Existing English language systematic analyses and guidelines were considered. DATA SYNTHESIS The mechanisms of CAC are multifaceted, but various cardioprotective therapies target many of these pathways. To date, anthracyclines and HER-2 targeted therapies have been the focus of cardioprotective trials to date as they are the most commonly implicated therapies in CAC. While traditional neurohormonal antagonists (ACEIs, ARBs, and beta blockers) and DEX performed favorably in many small clinical trials, the quality of available evidence remains limited. Hence, major guidelines lack consensus on an approach to primary prevention of CAC. Given the uncertain role of preventive therapy, monitoring for a symptomatic or asymptomatic decline in LV function is imperative with prompt evaluation should this occur. Numerous ongoing randomized controlled trials seek to either confirm the findings of these previous studies or identify new therapeutic agents to prevent CAC. Clinical implications are derived from the available literature as well as current guideline recommendations for CAC cardioprotection. CONCLUSION At this time, no single therapy has a clear cardioprotective benefit in preventing CAC nor is any therapy strongly recommended by current guidelines. Additional studies are needed to determine the optimal preventative regimens.

Achieving systemic tumor control across metastases is vital for long-term patient survival but remains intractable in many patients. High intrapatient heterogeneity persists, conferring many dissociated responses across metastatic lesions. Most studies of metastatic disease focus on tumor molecular and cellular features, which are crucial to elucidating the mechanisms underlying intrapatient heterogeneity. However, our understanding of intrapatient heterogeneity on the macroscopic level, such as lesion dynamics in growth, response, and relapse during treatment, remains rudimentary. This study investigated intrapatient heterogeneity through analyzing 116,542 observations of 40,612 lesions in 4,308 metastatic colorectal cancer (mCRC) patients. Despite significant differences in their response and relapse dynamics, metastatic lesions converged on four phenotypes that varied with anatomical site. Importantly, we found that organ-level relapse sequence was closely associated with patient survival, and that patients with the first relapses in the liver often had worse survival. In conclusion, our study provides insights into intrapatient response heterogeneity in mCRC and creates impetus for metastasis-specific therapeutics.

There is growing interest in utilizing pharmacogenetic (PGx) testing to guide antidepressant use, but there is lack of clarity on how to implement testing into clinical practice. We administered two surveys at 17 sites that had implemented or were in the process of implementing PGx testing for antidepressants. Survey 1 collected data on the process and logistics of testing. Survey 2 asked sites to rank the importance of Consolidated Framework for Implementation Research (CFIR) constructs using best‐worst scaling choice experiments. Of the 17 sites, 13 had implemented testing and four were in the planning stage. Thirteen offered testing in the outpatient setting, and nine in both outpatient/inpatient settings. PGx tests were mainly ordered by psychiatry (92%) and primary care (69%) providers. CYP2C19 and CYP2D6 were the most commonly tested genes. The justification for antidepressants selected for PGx guidance was based on Clinical Pharmacogenetics Implementation Consortium guidelines (94%) and US Food and Drug Administration (FDA; 75.6%) guidance. Both institutional (53%) and commercial laboratories (53%) were used for testing. Sites varied on the methods for returning results to providers and patients. Sites were consistent in ranking CFIR constructs and identified patient needs/resources, leadership engagement, intervention knowledge/beliefs, evidence strength and quality, and the identification of champions as most important for implementation. Sites deployed similar implementation strategies and measured similar outcomes. The process of implementing PGx testing to guide antidepressant therapy varied across sites, but key drivers for successful implementation were similar and may help guide other institutions interested in providing PGx‐guided pharmacotherapy for antidepressant management.

Considerable lesion-specific response heterogeneity exists in metastatic colorectal cancer patients, largely due to organ-specific ecological environments and evolutionary pressures. Metastatic lesions with poor response to therapy often become tumor sanctuary sites, leading to systemic resistance and tumor relapse. To map the lesion-specific response and relapse patterns, we investigated the longitudinal dynamics of individual lesions in metastatic colorectal cancer patients. Tumor longitudinal data in 4,308 colorectal cancer patients with 40,612 individual lesions were collected from eight Phase III trials in Project Data Sphere. First, tumor response dynamics (regression after treatment and progression upon resistance) were characterized using an empirical mathematical model. Next, tumor response time (when the lesion size decreases ≥20% from baseline) and relapse time (when the lesion size increases ≥30% from tumor nadir) were estimated for each individual lesion in patients being treated with bevacizumab, panitumumab, and/or chemotherapy. Random effect cox proportional models were applied to predict lesion-specific response and relapse probabilities and temporal sequence. We then took machine learning algorithm k-means to cluster patients based on their lesion relapse sequence. We found the response probabilities across organs are: Liver > Distal Lymph Nodes (LN) > Abdomen > Spleen > Lung > Regional LN > Adrenal > Muscle/Soft Tissue > Bone > Brain/CNS. Lesion relapse temporal sequence are: Brain/CNS > Liver > Adrenal > Muscle/Soft tissue > Abdomen > Bone > Spleen > Lung > Distal LN > Regional LN. Of note, lesions in the bone, brain, adrenal, and muscle/soft tissues often had low responses and high relapse probabilities, implying the greatest potential as tumor sanctuary sites. Liver, the most common metastatic organ in colorectal cancer, showed highest response rate but high relapse probabilities. Interestingly, the organ-specific response rate and relapse probabilities are respectively in line with drug distribution profiles and organ-specific immune landscape. Organ-specific relapse sequence in each patient is significantly correlated with patient long-term survival (p Citation Format: Jiawei Zhou, Quefeng Li, Amber Cipriani, Yanguang Cao. Mapping lesion specific response and relapse patterns in metastatic colorectal cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3789.