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Background
In December of 2023, a workgroup at VA Connecticut Healthcare System (“VACHS”) initiated a quality improvement project to use the weekly GI Tumor Board meeting to identify patients who would benefit from PHASER testing. The PHASER panel includes two genes that are involved in the metabolism of two commonly used chemotherapy drugs in this patient population. Our goal was to identify patients with potentially impaired metabolism of 5FU and/or irinotecan prior to initiating treatment so that the doses of the appropriate drugs could be adjusted, leading to less toxicity for patients while on treatment and fewer lingering side-effects from treatment.
Results
Here we report outcomes based on 12 months of data. We reviewed the charts of all patients who received 5-FU or irinotecan during the period 1/1/24-12/31/24 based on pharmacy records. We separately identified all VACHS patients with newly diagnosed GI cancers in 2024 using data generated by the Tumor Registrar. 39 patients met criteria for PHASER testing. Of those, 37/39 (95%) patients got the testing. The 2 additional patients who were identified during our data analysis will be offered PHASER testing. Of the 37 patients who were tested, 7 patients (19%) had a genetic variant that could potentially impact chemotherapy dosing. 3 of these 7 patients were treated with chemotherapy and did require dose-adjustment. Of note, 100% of patients diagnosed with a new GI malignancy at VA Connecticut in 2024 whose treatment plan included possible chemotherapy with 5FU or Irinotecan got PHASER testing. In one year, this best practice is now our standard procedure.
Conclusions
Despite access to pharmacogenomic testing at VA, there can be variations between VA sites in terms of uptake of this new testing. VA Connecticut’s PHASER testing initiative for patients with GI malignancies is a model that can be replicated throughout VA. This initiative is part of a broader focus at VACHS on “pre-habilitation” and pre-treatment testing that is designed to reduce toxicity of treatment and improve quality of life for cancer survivors.
Background
In December of 2023, a workgroup at VA Connecticut Healthcare System (“VACHS”) initiated a quality improvement project to use the weekly GI Tumor Board meeting to identify patients who would benefit from PHASER testing. The PHASER panel includes two genes that are involved in the metabolism of two commonly used chemotherapy drugs in this patient population. Our goal was to identify patients with potentially impaired metabolism of 5FU and/or irinotecan prior to initiating treatment so that the doses of the appropriate drugs could be adjusted, leading to less toxicity for patients while on treatment and fewer lingering side-effects from treatment.
Results
Here we report outcomes based on 12 months of data. We reviewed the charts of all patients who received 5-FU or irinotecan during the period 1/1/24-12/31/24 based on pharmacy records. We separately identified all VACHS patients with newly diagnosed GI cancers in 2024 using data generated by the Tumor Registrar. 39 patients met criteria for PHASER testing. Of those, 37/39 (95%) patients got the testing. The 2 additional patients who were identified during our data analysis will be offered PHASER testing. Of the 37 patients who were tested, 7 patients (19%) had a genetic variant that could potentially impact chemotherapy dosing. 3 of these 7 patients were treated with chemotherapy and did require dose-adjustment. Of note, 100% of patients diagnosed with a new GI malignancy at VA Connecticut in 2024 whose treatment plan included possible chemotherapy with 5FU or Irinotecan got PHASER testing. In one year, this best practice is now our standard procedure.
Conclusions
Despite access to pharmacogenomic testing at VA, there can be variations between VA sites in terms of uptake of this new testing. VA Connecticut’s PHASER testing initiative for patients with GI malignancies is a model that can be replicated throughout VA. This initiative is part of a broader focus at VACHS on “pre-habilitation” and pre-treatment testing that is designed to reduce toxicity of treatment and improve quality of life for cancer survivors.
Background
In December of 2023, a workgroup at VA Connecticut Healthcare System (“VACHS”) initiated a quality improvement project to use the weekly GI Tumor Board meeting to identify patients who would benefit from PHASER testing. The PHASER panel includes two genes that are involved in the metabolism of two commonly used chemotherapy drugs in this patient population. Our goal was to identify patients with potentially impaired metabolism of 5FU and/or irinotecan prior to initiating treatment so that the doses of the appropriate drugs could be adjusted, leading to less toxicity for patients while on treatment and fewer lingering side-effects from treatment.
Results
Here we report outcomes based on 12 months of data. We reviewed the charts of all patients who received 5-FU or irinotecan during the period 1/1/24-12/31/24 based on pharmacy records. We separately identified all VACHS patients with newly diagnosed GI cancers in 2024 using data generated by the Tumor Registrar. 39 patients met criteria for PHASER testing. Of those, 37/39 (95%) patients got the testing. The 2 additional patients who were identified during our data analysis will be offered PHASER testing. Of the 37 patients who were tested, 7 patients (19%) had a genetic variant that could potentially impact chemotherapy dosing. 3 of these 7 patients were treated with chemotherapy and did require dose-adjustment. Of note, 100% of patients diagnosed with a new GI malignancy at VA Connecticut in 2024 whose treatment plan included possible chemotherapy with 5FU or Irinotecan got PHASER testing. In one year, this best practice is now our standard procedure.
Conclusions
Despite access to pharmacogenomic testing at VA, there can be variations between VA sites in terms of uptake of this new testing. VA Connecticut’s PHASER testing initiative for patients with GI malignancies is a model that can be replicated throughout VA. This initiative is part of a broader focus at VACHS on “pre-habilitation” and pre-treatment testing that is designed to reduce toxicity of treatment and improve quality of life for cancer survivors.