Personalized Medicine

Question 1

Treatment Decisions are based on

Answer 1

Practice guidelines
Primary literature
Clinician experiences
Arbitrary guessing

Question 2

Inter-individual variability in

Answer 2

Development of diseases
Drug efficacy
Drug toxicity

Question 3

Personalized medicine has four groups

Answer 3

Responders
Non responders
Toxic responders
Non-toxic responders

Question 4

Average drug efficacy =

Answer 4

50% response rate, some are better than other and some are worse

Question 5

ADRs are most common with what drugs?

Answer 5

Diuretics
Opiods
Anticoagulants

Question 6

Application of PGx

Answer 6

Identify basis of inter-individual variability
Enable tailoring of therapy
Identity novel treatment approaches

Question 7

Single Gene Testing Required

Answer 7

UGT1A1
HER2
HLA-B*5701

Question 8

Microarray genotyping does how many genes?

Answer 8

500,000 genes on one chip

Question 9

What factors can affect PK and PD

Answer 9

Unidentified genetic factors
Environmental factors
Interactions

Question 10

Clopidogrel + CYP 2C19

Answer 10

It is a prodrug that is activated via CYP in the liver and then can go to decrease platelet activation and thrombus formation

Question 11

Intermediate metabolizers with clopidogrel have

Answer 11

52% increase risk of death from CV event

Question 12

Poor metabolizers with clopidogrel have

Answer 12

> 3.5 fold increase in risk of second CV event (lack effects of the drug)
Need an alternative agent

Question 13

Abacavir can cause

Answer 13

a hypersensitivity reaction with first 6 weeks and can be fatal if rechallenged

Question 14

Abacavir had what kind of approval?

Answer 14

Accelerate with contingencies (they had to be able to who would and wouldn’t have the hypersensitivity rxn)

Question 15

With and without genotyping how many people have the rxn

Answer 15

8% vs 3.5% with

Question 16

**Traditional Chemotherapy

Answer 16

Doxorubicin
Cyclophosphamide
Paclitaxel
Docetaxel

Question 17

**Targeted Chemotherapy

Answer 17

Trastuzumab

Question 18

**Hormonal Chemotherapy

Answer 18

Tamoxifen

Aromatase inhibitors

Question 19

80% are adequately treated with

Answer 19

surgery +/- radiation and hormonal therapy

Question 20

Chemotherapy can be beneficial how?

Answer 20

25% relative risk reduction for recurrence

High toxicity

Question 21

Oncotype Dx

Answer 21

21 gene assay

Some housekeeping genes and the cancer genes

Question 22

Low risk + Chemo

Answer 22

No benefit

Question 23

Intermediate risk + Chemo

Answer 23

No benefit statistically

Question 24

High score + Chemo

Answer 24

Significant improvement with chemo

Question 25

HER2 2/3+ Treatment

Answer 25

Trastuzumab

Question 26

ER Treatment

Answer 26

Tamoxifen or AI