Pharmacogenomics in Personalized Medicine: Clinical Impact and Future Directions

Pharmacogenomics is focused on genetic variation in drug pharmacokinetics and pharmacodynamics to enable a more tailored therapy dependent on the genomic variation of each patient.The objective of pharmacogenomics is to enhance the precision of therapy so that drug choice, dosing, adverse drug reactions and therapeutic likelihood of success are optimized across the domains of oncology, cardiology, psychiatry and infectious disease.The clinical potential involves the transfer of genotype to phenotype and actionable prescribing along with the integration of decision support into electronic health record (EHR) systems and trial design that is refined through biomarker selection.Implementation challenges require data standardization and applicability, validation and dissemination to clinicians and patients to support informed consent on uncertainties around the use of genomic data for drug choice and dosing as well as equitable access to novel targeted therapies.Future directions suggest an expanded polygenic and rare variant response model, integration of multi-omic data, clinical decision support for adaptive trial design and a learning health system to deliver iterative updated dosing algorithms based on feedback from standard clinical practice.