Cancer —
Training activity: 7

Details

Select, analyse, interpret and report the appropriate genomic testing for patients referred for pharmacogenomic testing, for example DPYD or 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 are the intended outcomes of the training activity?

• Do you have a clear understanding of how to select the laboratory testing strategy for pharmacogenetic testing (e.g., identifying specific DPYD variants) and the requirements for analysing, interpreting, and reporting these results for cancer patients?
• How will you apply your integrative knowledge of laboratory techniques and clinical guidelines (such as CPIC or DPWG) to investigate how a patient’s genotype influences their response to fluoropyrimidine therapies?
• What steps will you take to ensure you can demonstrate appropriate communication skills to present pharmacogenomic findings—including critical dose-adjustment recommendations—clearly to oncologists and other healthcare colleagues?
• What foundational knowledge regarding DPYD deficiency, fluoropyrimidine toxicity (e.g., 5-FU, capecitabine), and activity scoring systems do you need to acquire before embarking on this activity?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain regarding the clinical significance of pharmacogenomic markers and their role in preventing severe adverse drug reactions in cancer patients?
• Thinking about what you already know, which aspects of pharmacogenetic analysis—such as translating genotype to phenotype or managing rare/novel variants—do you find most challenging or interesting to explore?

What actions will you take in preparation for the experience?

• How will you gain clarity on the local pharmacogenomic testing pathway and the expectations for clinical reports?
• What challenges do you anticipate (e.g., the pressure of rapid turnaround times for pre-treatment screening or explaining complex dosing guidelines), and how have you planned to handle them?
• How do you feel about embarking on this activity, considering the direct impact that pharmacogenomic testing has on patient safety and the personalisation of cancer treatment?

In action

What are you doing?

• How are you currently approaching the selection and analysis of pharmacogenetic tests for cancer patients (e.g., identifying specific DPYD variants), and what real-time decisions are you making to ensure the strategy matches the clinical referral?
• Which aspects of the pharmacogenomic analysis feel intuitive, and where are you consciously relying on specific clinical guidelines or activity scoring systems (such as CPIC or DPWG) right now?

How are you progressing with the activity?

• How effective are your actions in achieving the pharmacogenetic profiling of the case, and what technical challenges—such as interpreting rare variants or calculating phenotype scores—are you encountering?
• How are you applying integrative knowledge of laboratory techniques as the data unfolds to ensure a comprehensive investigation of the patient’s likely drug response?

How are you adapting to the situation?

• What immediate support or alternative methodologies do you need to resolve ambiguous results or manage the pressure of pre-treatment screening timelines as they arise?
• How are you ensuring your communication of these findings, including critical dose-adjustment recommendations, is clear, accurate, and remains within your professional scope of practice?

On action

What did you notice?

• Summarise the key points of the pharmacogenomic referral and the specific laboratory testing strategy (e.g., genotyping for specific DPYD variants or expanded panels) you selected to investigate the case.
• What were the primary genetic findings (e.g., specific alleles identified and the resulting activity score), and were there any clinical details—such as the planned chemotherapy regimen—that significantly influenced your final analysis?

What did you learn from the activity?

• How did you improve your ability to integrate knowledge of laboratory techniques with international clinical guidelines (such as CPIC or DPWG) to provide a comprehensive interpretation of pharmacogenetic data?
• What insights did you gain from managing technical challenges—such as interpreting rare or novel variants—and how did your reflection-in-action during the analysis influence the final report and dosing recommendations?

What will you take from the experience moving forward?

• How will you apply the learning from this activity to your routine practice to ensure that critical dose-adjustment advice is communicated clearly and accurately to colleagues?
• What specific next steps or resources (e.g., updated pharmacogenomic databases or senior consultation) have you identified to further develop your skills in presenting these investigations within a multidisciplinary context?

Beyond action

Have you revisited the experiences?

• How has your perspective on selecting pharmacogenetic testing strategies (e.g., DPYD genotyping) evolved as you have gained more experience with other cancers or germline referrals?
• Have discussions with peers or colleagues changed how you view your earlier interpretations of complex pharmacogenomic findings, such as rare variants or borderline activity scores?
• Compare this experience with your Observed Training Activities—what specific laboratory behaviours and analytical practices for pharmacogenomic profiling have you now assimilated into your routine workflow?

How have these experiences impacted upon your current practice?

• How has your integrative knowledge of pharmacogenomics (e.g., correlating genotype to predicted phenotype) informed your current problem-solving when investigating other cases where genetic variation influences drug response?
• In what ways are you now applying the communication and presentation skills developed during this activity—particularly regarding critical dose-adjustment recommendations—to your wider interactions with clinical colleagues and the MDT?
• How is the learning from these DPYD cases helping you prepare for upcoming Case-based Discussions (CBDs) or other in-person assessments for this module?

How might these experiences contribute towards your future practice?

• What transferable skills—such as applying international clinical guidelines (e.g., CPIC/DPWG) or translating complex genetic data into clear clinical reports for treatment safety—will be most valuable as you progress toward becoming a Clinical Scientist?
• How will the principles learned here help you adapt to future advancements in pharmacogenomics, such as the implementation of broader pre-treatment panel testing or polygenic risk scores?
• What clear actions have you identified to continue developing your expertise in precision medicine and the molecular investigation of drug safety?

Relevant learning outcomes

#	Outcome
# 3	Outcome Select the laboratory testing strategy, analyse, interpret and report pharmacogenomic testing in cancer patients.
# 4	Outcome Apply integrative knowledge of laboratory techniques applied to the investigation of cases referred for cancer.
# 5	Outcome Demonstrate appropriate communication skills to present the results of investigations into acquired and germline cancer cases clearly to healthcare professional colleagues.