Pharmacy-Led Projects Wins Precision Health Investigators Award

Precision Health at the University of Michigan recently announced its 2021 Investigators Awardees, which include a project led by Pharmacy’s Amy Pasternak. The project, titled Assessing the Impact of Germline Pharmacogenetics (PGx) on Medication Outcomes and Clinician Prescribing Decisions in Patients with Cancer, will be supported by a $200k grant over two years.

“Many patients with cancer experience side effects to their cancer treatment,” explains Amy Pasternak, PharmD, Clinical Assistant Professor of Pharmacy and Clinical Pharmacist, Michigan Medicine. “With this award, we will investigate how pharmacogenetics could help to decrease the risk of a patient experiencing these side effects for different chemotherapies and for medications intended to help manage chemotherapy side effects.”

The project team includes Vaibhav Sahai, MBBS, MS, Associate Professor of Medical Oncology and Hematology, Daniel Hertz, PharmD, PhD, Assistant Professor of Pharmacy, and Valerie Gunchick, MS, Clinical Research Project Manager, and Kent Griffith, MS, MPH, Statistician.

Patients with cancer are commonly prescribed fluoropyrimidines (FP) or irinotecan, as well as supportive care medications to manage adverse effects (AE) of their cancer treatment. These medications have known risks for treatment inefficacy or severe toxicity based on pharmacogenetic (PGx) variation. Despite increasing evidence that genotype-guided strategies can mitigate risks of poorer medication outcomes, routine use of clinical PGx testing is uncommon. This study will aim to evaluate the impact of clinical PGx test results on clinician prescribing decisions and patient outcomes in a cohort of patients predicted to be at risk for AEs to their chemotherapy regimens based on Michigan Genomics Initiative (MGI) genotypes. Many PGx associations relevant to patients with cancer, such as dronabinol and CYP2C9 genotype are still considered investigational; this study will also leverage MGI to discover or validate additional PGx associations to establish workflows for future translation into prescribing decisions.

“This is a novel approach of using the MGI genetic data repository to identify patients with high risk of toxicity from their cancer treatment and inform dose adjustment to ensure safe dosing,” adds Dr. Hertz. “This highly efficient strategy could be a model that could be expanded to patient with other diseases to ensure that patients at Michigan Medicine receive maximally safe and effective treatment.”  

According to Precision Health, its Investigators Awards support new, collaborative research projects rooted in precision health to advance science and develop health innovations. This awards program aspires to nurture groundbreaking multidisciplinary research projects that advance the field.

Dr. Pasternak earned her PharmD from the Ohio Northern University Raabe College of Pharmacy in 2014. After graduation, she completed a PGY-1 Pharmacy Practice Residency at Cleveland Clinic Hillcrest Hospital in Mayfield Heights, OH. She then pursued specialty training in clinical pharmacogenetics as the PGY-2 Clinical Pharmacogenetics Resident at St. Jude Children’s Research Hospital in Memphis, TN, and as a Clinical Pharmacy Translational Fellow at the University of Michigan College of Pharmacy. Dr. Pasternak joined the U-M faculty as a Clinical Assistant Professor in 2018.  

Dr. Pasternak’s research has focused on the discovery and validation of pharmacogenetic associations, including assessing the functional consequence of genetic variation on UGT1A1 activity and the difference in the pharmacogenetic relationships among tacrolimus formulations. Additionally, her research has assessed the clinical impact of translating pharmacogenetics into patient care, which is the focus of her clinical practice at Michigan Medicine as part of the pharmacogenetics service. This consult-based service is available to answer patient and clinician questions regarding pharmacogenetics and integrating pharmacogenetic information into the prescribing process through clinical decision support.