Pharmacist-Led Implementation of Oncology Pharmacogenomic Testing of DPYD, UGT1A1, TPMT, and NUDT15 in Community and Rural Hospitals

Review Article

Abstract

Chemotherapy is a central modality in cancer care, yet severe adverse events frequently disrupt therapeutic regimens. Substantial interpatient variability in toxicity often arises from inherited polymorphisms in genes encoding drug-metabolizing enzymes. Pre-treatment screening for DPYD, UGT1A1, TPMT, and NUDT15 variants offer a validated mechanism to preempt life-threatening complications through genotype-guided dosing adjustments. Despite robust clinical guidelines from bodies such as the Clinical Pharmacogenetics Implementation Consortium, routine application is largely confined to academic centers, leaving patients in community and rural hospitals without standardized access to precision dosing. Infrastructure limitations, prolonged turnaround times for external laboratory results, and clinical knowledge gaps among providers constitute the primary impediments to widespread adoption. A scalable solution exists through pharmacist-led implementation models that integrate pharmacogenomic screening directly into established chemotherapy order verification workflows. Institutions can identify high-risk candidates by utilizing the pharmacist as a central coordinator and facilitate specimen collection at the point of diagnosis, and translate complex genetic data into actionable dosing modifications. Pre-emptive testing strategies, initiated at the time of cancer diagnosis rather than at the decision to treat, ensure that genomic profiles are available to clinicians before therapy begins. This approach reduces the risk of treatment delays and avoidable hospitalizations while enhancing health equity for underserved populations. Implementation of such screening protocols optimizes patient safety and provides a cost-effective pathway to normalize precision medicine in resource-limited oncology environments