Solid Cancers 2 —
Training activity: 11

Details

Analyse, interpret and report pharmacogenetic testing in oncology patients, to include:

• DPYD
• MGMT

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What is your understanding of DPYD and MGMT pharmacogenetics in oncology, including the relevant genetic variants and their impact on drug metabolism and efficacy?
• Are you familiar with the laboratory methods used for DPYD and MGMT testing?
• How do you interpret the results of these pharmacogenetic tests in the context of specific cancer treatments?
• What are the key elements to include in a pharmacogenetic report for oncology patients, including recommendations for dose adjustments or alternative therapies?
• Consider potential challenges you might face in interpreting complex or heterozygous results and their impact on treatment decisions.
• Review relevant clinical guidelines and literature on DPYD and MGMT pharmacogenetics and their impact on chemotherapy.
• Consider potential difficulties you might face in formulating clear and concise recommendations based on test results and think about how you might approach this.
• Reflect on the direct impact of pharmacogenetic testing on patient safety and treatment efficacy.

In action

• Pay attention to your actions. How are you approaching the analysis of the DPYDand MGMT genotypes? What specific variants are you focusing on? Why are you interpreting the results in a particular way? What decisions are you making about the likely impact of these genotypes on drug metabolism or response? What aspects of pharmacogenetic interpretation and reporting feel intuitive, and what requires more conscious effort (e.g., linking genotype to specific drug recommendations)? How urgent is the testing? How has this been determined?
• How effective are you at using relevant pharmacogenetic guidelines and resources to inform your interpretation? What challenges are you encountering during this activity (e.g., conflicting information, complex allele nomenclature)? What can you learn about pharmacogenetic testing in oncology as you work through these examples? How does this activity connect to your understanding of personalised medicine?
• Are there alternative ways you could be presenting the pharmacogenetic information in the report to ensure it is clinically actionable? Do you need to seek further information or guidance on the interpretation of specific DPYD or MGMT variants at this time? Are you ensuring that your report clearly outlines the implications for treatment?

On action

• What did you notice when analysing, interpreting, and reporting pharmacogenetic testing results for DPYD and MGMT in oncology patients? Summarise the key findings and any complexities encountered.
• What did you learn about the significance of DPYD and MGMT variants in predicting drug response and toxicity in oncology, and how to interpret these results in a clinical context? Were there any unexpected findings or challenges in the analysis or interpretation? What did you learn from these? Did any decisions you made during the analysis or interpretation impact the clinical recommendations in your report?
• What areas for further development in your pharmacogenetic analysis, interpretation, and reporting skills have been identified? How can you improve your skills in this area?

Beyond action

• Have you revisited your reflections on pharmacogenetic testing for DPYD and MGMT? How has your understanding of the clinical implications of variants in these genes evolved with further learning and experience?
• What key learning or actions related to the interpretation and reporting of pharmacogenetic markers are now more significant?
• Discuss challenging pharmacogenetic cases with colleagues or supervisors. Has this broadened your understanding of the complexities involved?
• How have subsequent experiences impacted upon your current practice in interpreting genomic data? Are you more aware of the importance of considering pharmacogenetic implications in oncology?
• How has your ability to analyse, interpret, and report pharmacogenetic findings developed since this activity, especially as new pharmacogenetic markers become clinically relevant?

Relevant learning outcomes

#	Outcome
# 2	Outcome Analyse, interpret and prepare interpretive reports of clinically relevant findings for patients with central nervous system (CNS), sarcoma tumours, and somatic and germline variants in ovarian and breast cancer.
# 4	Outcome Interpret QC data including bioinformatic and NGS quality metrics in relation to assay performance, EQA and ISO:15189 standards.
# 5	Outcome Analyse, interpret and prepare interpretive reports for circulating tumour DNA (ctDNA) testing in solid tumours, to include lung and breast cancer.
# 6	Outcome Analyse, interpret and prepare interpretive pharmacogenetic reports in oncology patients.