Knowledge and Attitudes on Germline Pharmacogenomic Testing Among Clinical Oncologists.

Abstract

Purpose: Despite increasing evidence supporting the validity and utility of pharmacogenomic (PGx)-guided prescribing, clinical PGx testing in oncology remains limited. However, expanding professional guidelines and recommendations have accelerated PGx implementation efforts in the United States. Given the availability of actionable PGx guidelines for several medications commonly prescribed to patients with cancer, this study evaluated US oncologists' knowledge, attitudes, and perceived barriers regarding PGx-guided medication management.

Methods: A survey focused on oncology-relevant medications with actionable PGx guidelines, including fluoropyrimidines, thiopurines, irinotecan, and opiates/antidepressants, was distributed to clinical oncologists in the United States from December 2023 to August 2024 through ASCO Research Survey Pool, the Association of Northern California Oncologists, and regional ASCO-affiliated groups.

Results: A total of 146 providers completed the survey, most through ASCO (n = 125). Opiates and antidepressants were the most frequently prescribed medications in the previous 6 months (92%), followed by fluoropyrimidines (75%). Nearly all respondents (93%) had heard of PGx, although most were only moderately familiar (57%), and PGx awareness for chemotherapies (92%) was much greater than opiates/antidepressants (47%). Reported barriers to PGx testing for chemotherapy management included uncertain utility, concerns for treatment delay, and unclear National Comprehensive Cancer Network recommendations, and barriers for opiate/antidepressant management included uncertain utility, lack of awareness, and uncertainty regarding test ordering and result interpretation.

Conclusion: These findings provide valuable insights into the perspectives of oncologists on implementing PGx testing; however, awareness and utilization were higher than previously reported. Importantly, the identified implementation barriers for oncology are both actionable and timely, particularly given the evolving updates to drug labels and professional guidelines supporting PGx testing for medications relevant to patients with cancer.