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News
Most oncologists know genetic variants affect chemotherapy safety, and over half are testing for them — but a major blind spot remains. More than 90% prescribe antidepressants or opioids to cancer patients, yet fewer than half are aware of key drug-gene interactions for these supportive medications. Experts say education, clearer guidelines, and better clinical workflows are urgently needed to close the gap.
Good news first: a new survey of 146 oncologists found that over 90% are aware that genetic variants can affect chemotherapy drugs like fluoropyrimidines, thiopurines, and irinotecan — and more than half have already ordered pharmacogenomic testing before prescribing. Experts call this "really encouraging," especially as recent FDA label updates and NCCN guideline changes now formally recommend DPYD testing before fluoropyrimidine treatment.
But here's the catch: the same oncologists have a significant blind spot when it comes to supportive medications. Nearly all (92%) prescribed antidepressants and/or opioids to cancer patients, yet only 46% were aware of actionable interactions with the CYP2D6 gene — and just 12% had ever ordered CYP2D6 testing. The majority said they were unlikely or very unlikely to start testing in the future.
Key Takeaways:
Why it matters: Pharmacogenomic-guided prescribing can prevent life-threatening toxicities and improve outcomes — but only if clinicians apply it across all medications, not just chemotherapy. Experts are calling for targeted education, streamlined workflows, and pharmacy support to make this standard of care.
