Pharmacogenomics using Whole-Exome Sequencing in Oncology Clinics: Clinical Workflows, Outcomes, and Cost-Effectiveness
Pharmacogenomics leverages genomic information to optimize drug therapy, improving efficacy and minimizing toxicity in oncology patients. Whole-exome sequencing (WES) provides a comprehensive platform for identifying clinically actionable variants in germline and tumor DNA, enabling personalized treatment selection and dose adjustment. WES-based pharmacogenomic workflows encompass patient selection, informed consent, sample acquisition, sequencing, variant annotation, clinical reporting, and integration into multidisciplinary care. Evidence indicates that pharmacogenomic-guided therapy can reduce adverse drug reactions, maintain chemotherapy dose intensity, and enhance targeted therapy outcomes. Economic analyses suggest potential cost savings through the prevention of drug-related complications, though formal cost-effectiveness remains contextdependent. Despite technical and methodological challenges, WES-guided pharmacogenomics represents a promising approach to precision oncology, with ongoing data accumulation likely to expand its clinical utility and integration into routine care.