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Pharmacogenomics, CYP2D6, and Tamoxifen: A Survey of the Reasons Sustaining European Clinical Practice Paradigms

1
School of Engineering and CIETI, Porto Polytechnic (P. Porto), 4249-015 Porto, Portugal
2
Institute of Bioethics, Portuguese Catholic University, 4169- 005 Porto, Portugal
3
School of Health, Porto Polytechnic (P. Porto), 4200-072 Porto, Portugal
4
Institute for Research and Innovation in Health (i3S), Porto University, 4200-135 Porto, Portugal
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(7), 344; https://doi.org/10.3390/medicina55070344
Received: 27 March 2019 / Revised: 28 June 2019 / Accepted: 1 July 2019 / Published: 5 July 2019
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Abstract

Tamoxifen is a drug that is often used in the clinical management of breast cancer. CYP2D6 is a key metabolizing enzyme that is involved in the conversion of tamoxifen to its active drug metabolites. CYP2D6 has several alleles that metabolize tamoxifen and other drugs at different rates that can alter therapeutic impact, a characteristic that renders it one of the most studied enzymes in the field of pharmacogenetics. Background and objectives: Portugal has no implemented measures based on pharmacogenomics analysis prior to therapy that might function as a cultural sample control when analyzing the individual and economic factors present in clinical practice paradigms. Therefore, we aim to investigate the impact of CYP2D6 genotyping of the tamoxifen metabolizing enzymes in the clinical management of breast cancer patients. Materials and Methods: Qualitative/quantitative studies regarding the impact of pharmacogenomics in breast cancer; personal interviews in different Portuguese laboratories within hospital setting using a survey. Analysis of data through interviews to management board and/or decision makers from major oncological centers. Results: Reasons for common adoption of pharmacogenomics practice are contradictory and based both in economic factors and cultural/clinical bias. Conclusions: This research study identifies specific cultural and/or clinical bias that act as obstacles to pharmacogenomic implementation and proposes viable courses of action that might bring about change in cultural/medical habits. View Full-Text
Keywords: pharmacogenomics; clinical policies; clinical bias; breast cancer; tamoxifen; CYP2D6; hormone therapy; cultural sample control pharmacogenomics; clinical policies; clinical bias; breast cancer; tamoxifen; CYP2D6; hormone therapy; cultural sample control
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Reis, S.S.; Carvalho, A.S.; Fernandes, R. Pharmacogenomics, CYP2D6, and Tamoxifen: A Survey of the Reasons Sustaining European Clinical Practice Paradigms. Medicina 2019, 55, 344.

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