table 1: selected Personalized Medicine drugs,
treatments, and diagnostics as of March 2009*
BIOMARKER/TEST INDICATION Herceptin® (trastuzumab)
her-2/neu receptor Breast cancer: “…for the treatment of patients with metastatic breast cancer whose tumors over- Tykerb® (lapatinib)
express the her2 protein and who have received one or more chemotherapy regimens for their metastatic disease.”
Pharmaceutical and surgical BRCA 1,2 Breast cancer: Guides surveillance and preventive treatment based on susceptibility risk for breast prevention options and surveillance Tamoxifen
aviara Breast cancer Breast cancer: calculates a combined risk analysis for recurrence after tamoxifen treatment for indexsM (HOXB13,
er-positive, node-negative breast cancer. Chemotherapy Breast cancer: Prognostic immunohistochemistry (ihc) test used for postmenopausal, node negative, estrogen receptor expressing breast cancer patients who will receive hormonal therapy and are considering adjuvant chemotherapy. Chemotherapy Breast cancer: assesses risk of distant metastasis in a 70 gene expression profile. Coumadin® (warfarin) Cardiovascular disease: “an increased bleeding risk for patients carrying either the CYP2C9*2 or CYP2C9*3 alleles.” Coumadin® (warfarin) Cardiovascular disease: “certain single nucleotide polymorphisms in the VKORC1 gene (espe- cially the -1639G>a allele) have been associated with lower dose requirements for warfarin.” Coumadin® (warfarin) Cardiovascular disease: determines CYP2C9 and VKORC1 genotypes to predict likelihood of
adverse events with warfarin therapy. Coumadin® (warfarin) Cardiovascular disease: hereditary or acquired deficiencies of protein c or its cofactor, protein s,
has been associated with tissue necrosis following warfarin administration. Pharmaceutical and lifestyle Familion® 5-gene Cardiovascular disease: Guides prevention and drug selection for patients with inherited cardiac prevention options
channelopathies such as long Qt syndrome (lQts), which can lead to cardiac rhythm abnormalities. Cardiovascular disease: Predicts risk of statin-induced neuro-myopathy, based on a patient’s combinatorial genotype for 50 genes. Atorvastatin Cardiovascular disease: “doses should be individualized according to the recommended goal of therapy. homozygous Familial hypercholestremia (10-80mg/day)and heterozygous (10-20mg/ day).” Camptosar® (irinotecan) Colon cancer: “variations in the UGT1A1 gene can influence a patient’s ability to break down irinotecan, which can lead to increased blood levels of the drug and a higher risk of side effects.” Erbitux® (cetuximab) Colon cancer: “Patients enrolled in the clinical studies were required to have…evidence of posi- Gefitinib
tive EGFR expression using the dakocytomation EGFR pharmdx™ test kit.” EGFR positive
Vectibix® (panitumab)
individuals are more likely to respond to the drug than those with reduced EGFR expression. Erbitux® (cetuximab) Colon cancer: certain KRAS mutations lead to unresponsiveness to the drug. Gefitinib Vectibix® (panitumab) Erbitux® (cetuximab) and Colon cancer: Provides information of the expression of key molecular targets—KRAS, TS, and Vectibix® (panitumab) Fluorouracil Camptosar® (irinotecan) Tagretol (carbamazepine) Epilepsy and bipolar disorder: serious dermatologic reactions are associated with the HLA- B*1502 allele in patients treated with carbamazepine. “Prior to initiating tegretol therapy, testing for HLA-B*1502 should be performed in patients with ancestry in populations in which HLA- B*1502 may be present.” Immunosuppressive drugs Heart transplantation: Monitors patient’s immune response to heart transplant to guide immu- Ziagen® (abacavir) HIV: “Patients who carry the HLA-B*5701 allele are at high risk for experiencing a hypersensitiv- ity reaction to abacavir. Prior to initiating therapy with abacavir, screening for the HLA-B*5701 allele is recommended.” HIV: “selzentry, in combination with other antiretroviral agents, is indicated for treatment experi- enced adult patients infected with only ccr5-tropic hiv-1 detectable.” 18 The Case for Personalized Medicine Personalized Medicine Coalition. The Case for Personalized Medicine. May 2009. Inflammatory bowel disease: identifies subset of patients who will benefit from budesonide. Leukemia: “Gleevec® (imatinib mesylate) is indicated for the treatment of newly diagnosed adult and pediatric patients with Philadelphia chromosome positive [indicated by presence of BCR- ABL] chronic myeloid leukemia (cMl) in chronic phase.” Leukemia: “dasatinib is indicated for the treatment of adults with Philadelphia chromosome-
positive acute lymphoblastic leukemia (Ph+ all) with resistance or intolerance to prior therapy”
Leukemia: “Busulfan is clearly less effective in patients with chronic myelogenous leukemia who
lack the Philadelphia (Ph1) chromosome.”
Leukemia: Guides adjustment of dose in treatment of acute lymphoblastic leukemia: “Patients
with inherited little or no thiopurine s-methyltransferase (tPMt) activity are at increased risk for
severe Purinethol toxicity from conventional doses…”
Lung cancer: the test determines patients most likely to respond. Multiple cancers: “rarely, unexpected severe toxicity (e.g., stomatitis, diarrhea, neutropenia and neurotoxicity) associated with 5-fluorouracil has been attributed to a deficiency of dihydropyrimi- dine dehydrogenase (dPd) activity.” Multiple cancers: Guides surveillance and preventive treatment based on susceptibility risk for Multiple cancers: determines cancer classification for tumors of unknown primary origin.
aviara cancertyPe Multiple cancers: classifies 39 tumor types from tumors of unknown primary origin, using a id® Multiple cancers: “rasburicase administered to patients with glucose- phosphate dehydrogenase (G6Pd) deficiency can cause severe hemolysis. … it is recommended that patients at higher risk for G6Pd deficiency … be screened prior to starting eliteK therapy.” Multiple diseases: Fda classification 21 cFr 862.3360: “this device is used as an aid in deter-
mining treatment choice and individualizing treatment dose for therapeutics that are metabolized primarily by the specific enzyme about which the system provides genotypic information.”
2C19: celecoxib, codeine, diaz- epam, esomeprazole, nelfinavir, omeprazole, Pantoprazole, rabepra- zole, voriconazole 2D6: acetaminophen, aripiprazole, atomoxetine, carvedilol, cevimeline hydrochloride, clozapine, Fluoxetine hcl, Fluoxetine hcl and olan- zapine, Metoprolol, Propranolol, Propafenone, Protriptyline hcl, risperidone, tamoxifen, terbinafine, thioridazine, timolol maleate, tiotropium bromide inhalation, tolt- erodine, tramadol, venlafaxine Multiple diseases: n-acetyltransferase slow and fast acetylators and toxicity- “slow acetylation
may lead to higher blood levels of the drug, and thus, an increase in toxic reactions.”
Non-Hodgkin’s lymphoma: detects cd-20 variant (polymorphism in the igG Fc receptor gene FcgRIIIa) to predict response to cancer drug rituximab. Pain: “Patients who are known or suspected to be P450 2c9 poor metabolizers based on a previ- ous history should be administered celecoxib with caution as they may have abnormally high plasma levels due to reduced metabolic clearance.” Psychiatric disorders: Predicts risk of psychotropic-induced metabolic syndrome, based on a
patient’s combinatorial genotype for 50 genes. Stomach cancer: “Gleevec® is also indicated for the treatment of patients with Kit (CD117) posi- tive unresectable and/or metastatic malignant gastrointestinal stromal tumors (Gist).”
*This list is not intended to be comprehensive but reflects commonly used or available products as of March 2009. Some products, for which the FDA recommends or requires pharmacogenomic testing or which
have pharmacogenomic information in their label, are listed at the FDA’s Web site (http://www.fda.gov/cder/genomics/genomic_biomarkers_table.htm). Other listed products that are novel, and/or that address
large populations, have been identified via websites and public announcements.
Indications in quotes are taken from the therapeutic product label. BCR-ABL = breakpoint cluster region – Abelson
BRCA 1,2 = breast cancer susceptibility gene 1 or 2
HER2 = human epidermal growth factor receptor 2
UGT1A1 = UDP-glucuronosyltransferase 1A1
The Case for Personalized Medicine 19
Do representations of male muscularity differ inDavid A. Frederick , Daniel M.T. Fessler, Martie G. Haselton1285 Franz Hall, Department of Psychology, 3rd Floor Mailroom, University of California, Los Angeles, CA 90095, USAReceived 1 October 2004; received in revised form 20 December 2004; accepted 21 December 2004Men overestimate the degree of muscularity that is attractive to women, an