Treatment Options and Individualized Medicine

  • Mouldy Sioud
  • Øyvind Melien
Part of the Methods in Molecular Biology™ book series (MIMB, volume 361)


Although several drug targets are identified, current strategies in therapy do not take into account that patients vary in their response to drugs, both with respect to efficacy and toxic side effects. Whereas both clinical and histopathologic predictors of prognosis are established in some diseases, a better understanding of the molecular mechanisms that determine treatment response should play an important role in the development of individualized medicine. Treatment optimization will rely on the ability to adjust treatment algorithms for use in the individual patient based on the identification and validation of the factors that critically determine treatment outcomes, including diagnosis, disease phase and characteristics, organ functions, age, and gender. Although the analysis of a single genetic marker (e.g., CYP polymorphisms) may yield significant information that predicts drug response, the prediction obtained from the analysis of several genetic and epigenetic markers is potentially more powerful in selecting patients for effective therapy, whereas sparing those who would not respond or would suffer undesirable side effects. In this chapter, several relevant examples are presented.

Key Words

Individualized medicine genomics proteomics gene profiling genetic variations polymorphisms breast cancer lymphoma leukemia 


  1. 1.
    Bell, J. (2004) Predicting disease using genomics. Nature 429, 453–456.CrossRefPubMedGoogle Scholar
  2. 2.
    Meyer, U. A. (2004) Pharmacogenetics: five decades of therapeutic lessons from genetic diversity. Nat. Rev. Genet. 5, 669–676.CrossRefPubMedGoogle Scholar
  3. 3.
    Lai, E. (2001) Application of SNP technologies in medicine: lessons learned and future challenges. Genome Res. 11, 927–929.CrossRefPubMedGoogle Scholar
  4. 4.
    Huang, E., Cheng, S. H., Dressman, H., et al. (2003) Gene expression predictors of breast cancer outcomes. Lancet 361, 1590–1596.CrossRefPubMedGoogle Scholar
  5. 5.
    Wilkinson, G. R. (2005) Drug metabolism and variability among patients in drug response N. Engl. J. Med. 352, 2211–2221.CrossRefPubMedGoogle Scholar
  6. 6.
    Williams, R. S. and Goldschmidt-Clermont, P. J. (2004) The genetics of cardiovascular disease: from genotype to phenotype. Dialogues in Cardiovasc. Med. 9, 3–19.Google Scholar
  7. 7.
    Dixon, K. and Kopras, E. (2004) Genetic alterations and DNA repair in human carcinogenesis. Semin in Cancer Biol. 14, 441–448.CrossRefGoogle Scholar
  8. 8.
    Liotta, L. A. and Kohn, E. C. (2001) The microenvironment of the tumour-host interface. Nature 411, 375–379.CrossRefPubMedGoogle Scholar
  9. 9.
    Staudt, L. M. (2002) Gene expression profiling of lymphoid malignancies. Annu. Rev. Med. 53, 303–318.CrossRefPubMedGoogle Scholar
  10. 10.
    Ingelman-Sundberg, M. (2005) The human genome project and novel aspects of cytochrome P450 research. Toxicol Appl Pharmacol 207, 52–56.CrossRefPubMedGoogle Scholar
  11. 11.
    Gajecka, M., Rydzanicz, M., Jaskula-Sztul, R., Kujawski, M., Szyfter, W., and Szyfter, K. (2005) CYP1A1, CYP2D6, CYP2E1, NAT2, GSTM1 and GSTT1 polymorphisms or their combinations are associated with the increased risk of the laryngeal squamous cell carcinoma. Mut. Res. 574, 112–123.Google Scholar
  12. 12.
    Raimondi, S., Boffetta, P., Anttila, S., et al. (2005) Metabolic gene polymorphisms and lung cancer risk in non-smokers. An update of the GSEC study. Mut. Res. 592, 45–47.Google Scholar
  13. 13.
    Efferth, T. and Volm, M. (2005) Gluthatione-related enzymes contribute to resistance of tumor cells and low toxicity in normal organs to artesunate. In Vivo 19, 225–232.PubMedGoogle Scholar
  14. 14.
    Anderer, G., Schrappe, M., Brechlin, A. M., et al. (2000) Polymorphisms within glutathione S-transferase genes and initial response to glucocorticoids in childhood acute lymphoblastic leukaemia. Pharmacogenetics 10, 715–726.CrossRefPubMedGoogle Scholar
  15. 15.
    Efferth, T. and Volm, M. (2005) Pharmacogenetics for individualized cancer chemotherapy. Pharmacology Therapeutics 107, 155–176.CrossRefPubMedGoogle Scholar
  16. 16.
    Toffoli, G., Cecchin, E., Corona, G., and Boiocchi, M. (2003) Pharmacogenetics of irinotecan. Curr. Med. Chem. Anti-Canc. Agents 3, 225–237.CrossRefGoogle Scholar
  17. 17.
    Yamayoshi, Y., Iida, E., and Tanigawara, Y. (2005) Cancer pharmacogenomics: international trends. Int. J. Clin. Oncol. 10, 5–13.CrossRefPubMedGoogle Scholar
  18. 18.
    Van Kuilenburg, A. B., Muller, E. W., Haasjes, J., et al. (2001) Lethal outcome of a patient with a complete dihydropyrimidine dehydrogenase DPD deficiency after administration of 5′fluorouracil: frequency of the common IVS14+1G>A mutation causing dpd deficiency. Clin. Cancer Res. 7, 1149–1153.PubMedGoogle Scholar
  19. 19.
    Costea, I., Moghrabi, A., and Krajinovic, M. (2003) The influence of cyclin D1 (CCND1) 870A>G polymorphism and CCND1-thymidylate synthase (TS) genegene interaction on the outcome of childhood acute lymphoblastic leukaemia. Pharmacogenetics 13, 577–580.CrossRefPubMedGoogle Scholar
  20. 20.
    Lynch, T. J., Bell, D. W., Sordella, R., et al. (2004) Activating mutations in the Epidermal Gorowth Factor Receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N. Engl. J. Med. 350, 2129–2139.CrossRefPubMedGoogle Scholar
  21. 21.
    Piccart, M. J., Di Leo, A., and Hamilton, A. (2000) HER2: a predictive factor ready to use in the daily management of breast cancer patient? Eur. J. Cancer 36, 1755–1761.CrossRefPubMedGoogle Scholar
  22. 22.
    Duffy, M. J. (2002) Urokinase plasminogen activator and its inhibitor, PAI-1, as prognostic marlers in breast cancer: from pilot to level 1 evidence studies. Clin. Chem. 48, 1194–1197.PubMedGoogle Scholar
  23. 23.
    Andreasen, P. A., Kjoller, L., Christensen, L., and Duffy, M. J. (1997) The urokinase-type plasminogen activator in cancer metastasis: a review. Int. J. Cancer 72, 1–22.CrossRefPubMedGoogle Scholar
  24. 24.
    Efferth, T. (2001) The human ATP-binding cassette transporter genes: from the bench to the bedside. Curr. Mol. Med. 1, 45–65.CrossRefPubMedGoogle Scholar
  25. 25.
    Hoffmeyer, S., Burk, O., von Richter, O., et al. (2000) Functional polymorphisms of the human multidrug-resistance gene: multiple sequence variations and correlation of one allele with P-glycoprotein expression and activity in vivo. Proc. Natl. Acad. Sci. USA 97, 3473–3478.CrossRefPubMedGoogle Scholar
  26. 26.
    Lesko, L. J. and Woodcock, J. (2004) Translation of pharmacogenomics and pharmacogenetics: a regulatory perspective. Nat. Rev. Drug Discov. 3, 763–769.CrossRefPubMedGoogle Scholar
  27. 27.
    Margalit, O., Somech, R., Amariglio, N., and Rechavi, G. (2005) Microarray-based gene expression profiling of hematologic malignancies: basic concepts and clinical applications. Blood Rev. 19, 223–234.CrossRefPubMedGoogle Scholar
  28. 28.
    Sorlie, T., Perou, C. M., Tibshirani, R., et al. (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc. Natl. Acad. Sci. USA 98, 10,869–10,874.CrossRefPubMedGoogle Scholar
  29. 29.
    Stock, M. and Otto, F. (2005) Gene deregulation in gastric cancer. Gene 360, 1–19.CrossRefPubMedGoogle Scholar
  30. 30.
    Terra, S. G., Hamilton, K. K., Pauly, D. F., et al. (2005) β1-adrenergic receptor polymorphisms and left ventricular remodeling changes in response to β-blocker therapy. Pharmacogen. Genom. 15, 227–234.CrossRefGoogle Scholar
  31. 31.
    Kaye, D. M., Smirk, B., Williams, C., Jennings, G., Esler, M., and Holst, D. (2003) β-Adrenoceptor genotype influences the response to carvedilol in patients with congestive heart failure. Pharmacogen. 13, 379–382.CrossRefGoogle Scholar
  32. 32.
    Rigat, B., Hubert, C., Alhenc-Gelas, F., Cambien, F., Corvol, P., and Soubrier, F. (1990) An insertion/deletion polymorphism in the angiotensin I-converting enzyme gene accounting for half the variance of serum enzyme levels. J. Clin. Invest. 86, 1343–1346.CrossRefPubMedGoogle Scholar
  33. 33.
    Ihnken, R., Verho, K., Gross, M., and Marz, W. (1996) Deletion polymorphism of the angiotensin I-converting enzyme gene is associated with increased plasma angiotensin-converting enzyme activity but not with increased risk for myocardial infarction and coronary artery disease. Ann. Intern. Med. 125, 19–25.PubMedGoogle Scholar
  34. 34.
    Andersson, B. and Sylven, C. (1996) The DD genotype of the angiotensin-converting enzyme gene is associated with increased mortality in idiopathic heart failure. J. Am. Coll. Cardiol. 28, 162–167.CrossRefPubMedGoogle Scholar
  35. 35.
    McNamara, D. M., Holubkov, R., Postava, L., et al. (2004) Pharmacogenetic interactions between angiotensin-converting enzyme inhibitor therapy and angiotensin-converting enzyme deletion polymorphism in patients with congestive heart failure. J. Am. Coll. Cardiol. 44, 2019–2026.CrossRefPubMedGoogle Scholar
  36. 36.
    Spiering, W., Kroon, A. A., Fuss-Lejeune, M. J. M. J., and Leeuw, P. W. (2005) Genetic contribution to the acute effects of angiotensin II type 1 receptor blockade. J. Hypertens. 23, 753–758.CrossRefPubMedGoogle Scholar
  37. 37.
    Nürnberger, J., Dammer, S., Mitchell, A., et al. (2003) Effect of the C825T polymorphism of the G protein β3 subunit on the systolic blood pressure-lowering effect of clonidine in young, healthy male subjects. Clin. Pharmacol. Ther. 74, 53–60.CrossRefPubMedGoogle Scholar
  38. 38.
    Mitchell, A., Buhrmann, S., Seifert, A., et al. (2003) Venous response to nitroglycerin is enhanced in young, healthy carriers of the 825T allele of the G protein beta3 subunit gene (GNB3). Clin. Pharmacol. Ther. 74, 499–504.CrossRefPubMedGoogle Scholar
  39. 39.
    Rozalski, M., Boncler, M., Luzak, B., and Watala, C. (2005) Genetic factors underlying differential blood platelet sensitivity to inhibitors. Pharmacol Reports 57, 1–13.Google Scholar
  40. 40.
    Schmitz, G. and Drobnik, W. (2003) Pharmacogenomics and pharmacogenetics of cholesterol-lowering therapy. Clin. Chem. Lab Med. 41, 581–589.CrossRefPubMedGoogle Scholar
  41. 41.
    Higashi, M. K., Veenstra, D. L., Kondo, L. M., et al. (2002) Association between CYP2C9 genetic variants and anticoagulation-related outcomes during warfarin therapy. JAMA 287, 1690–1698.CrossRefPubMedGoogle Scholar
  42. 42.
    Rieder, M. J., Reiner, A. P., Gage, B. F., et al. (2005) Effect of VKORC1 Haplotypes on transcriptional regulation and warfarin dose. N. Engl. J. Med. 352, 2285–2293.CrossRefPubMedGoogle Scholar
  43. 43.
    Sconce, E. A., Khan, T. I., Wynne, H. A., et al. (2005) The impact of CYP2C9 and VKORC1 genetic polymorphism and patient characteristics upon warfarin dose requirements: proposal for a new dosing regimen. Blood 106, 2329–2333.CrossRefPubMedGoogle Scholar
  44. 44.
    Israel, E., Drazen, J. M., Liggett, S. B., et al. (2000). The effect of polymorphisms of the beta(2)-adrenergic receptor on the response to regular use of albuterol in asthma. Am. J. Respir. Crit. Care Med. 162, 75–80.PubMedGoogle Scholar
  45. 45.
    Taylor, D. R., Drazen, J. M., Herbison, G. P., et al. (2000) Asthma exacerbations during long term beta agonist use: influence of beta(2) adrenoceptor polymorphism. Thorax 55, 762–767.CrossRefPubMedGoogle Scholar
  46. 46.
    Israel, E., Chinchilli, V. M., Ford, J. G., et al. (2004) Use of regularly scheduled albuterol treatment in asthma: genotype-stratified, randomised, placebo-controlled cross-over trial. Lancet 364, 1505–1512.CrossRefPubMedGoogle Scholar
  47. 47.
    Drysdale, C. M., McGraw, D. W., Stack, C. B., et al. (2000) Complex promoter and coding region β2-adrenergic receptor haplotypes alter receptor expression and predict in vivo responsiveness. Proc. Acad. Natl. Sci. USA 97, 10,483–10,488.CrossRefGoogle Scholar
  48. 48.
    Tantisira, K. G., Small, K. M., Litonjua, A. A., Weiss, S. T., and Liggett, S. B. (2005) Molecular properties and pharmacogenetics of a polymorphism of adenylyl cyclase type 9 in asthma: interaction between β-agonist and corticosteroid pathways. Hum. Mol. Gen. 14, 1671–1677.CrossRefPubMedGoogle Scholar
  49. 49.
    Drazen, J. M., Yandava, C. N., Dube, L., et al. (1999) Pharmacogenetic association between ALOX5 promoter genotype and the response to anti-asthma treatment. Nat. Genet. 22, 168–170.CrossRefPubMedGoogle Scholar
  50. 50.
    Ioannidis, J. P. A., Rosenberg, P. S., Goedert, J. J., et al. (2001) Effects of CCR5-32, CCR2-64I, and SDF-1 3′A alleles on HIV-1 disease progression: an international metaanalysis of individual-patient data. Ann. Intern. Med. 135, 782–795.PubMedGoogle Scholar
  51. 51.
    Passam, A., Zafiropoulos, A., Miyakis, S., et al. (2005) CCR2-64I and CXCL123′A alleles confer a favorable prognosis to AIDS patients undergoing HAART therapy. J. Clin. Virol. 34, 302–309.CrossRefPubMedGoogle Scholar
  52. 52.
    Sarrazin, C., Berg, T., Weich, V., et al. (2005) GNB3 C825T polymorphism and response to interferon-alfa/ribavirin treatment in patients with hepatitis C virus genotype 1 (HCV-1) infection. J. Hepatol. 43, 388–393.CrossRefPubMedGoogle Scholar
  53. 53.
    Lindemann, M., Barsegian, V., Siffert, W., et al. (2002) Role of G protein beta3 subunit 825T and HLA class II polymorphisms in the immune response after HBV vaccination. Virology 297, 245–252.CrossRefPubMedGoogle Scholar
  54. 54.
    Hauge Opdal, S., Melien, Ø., Rootwelt, H., Vege, Å., Arnestad, M., and Rognum, T. O. (2006) The G protein β3 subunit 825C allele is associated with sudden infant death due to infection, teta paediatre, in presst.Google Scholar

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Mouldy Sioud
    • 1
  • Øyvind Melien
    • 2
  1. 1.Department of Immunology, Institute for Cancer Research, The Norwegian Radium HospitalUniversity of OsloOsloNorway
  2. 2.Clinical Research Unit, Section of Clinical PharmacologyRikshospitalet University HospitalOsloNorway

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