Individualized Medicine Clinic expands services

The mission of Mayo Clinic's Center for Individualized Medicine (CIM) is to discover and translate genomic and molecular science into personalized medical applications. In addition to research DNA sequencing and genotyping, the center supports programs in pharmacogenomics, clinomics, epigenomics and microbiome analysis that affect patient care.

In 2012, the clinomics program of CIM expanded to include an Individualized Medicine (IM) Clinic on all three Mayo campuses. The clinic, which focuses exclusively on incorporating advances in genomic science into clinical practice, offers whole-exome sequencing for advanced cancer and diagnostic odyssey cases.

Beginning in late summer 2014, the IM Clinic will also offer genomic testing for polymorphisms in drug-metabolizing enzymes and for genetic variants associated with increased cancer risk as well as DNA sequencing for inherited disease.

"We are trying to build a clinical service based on genomics testing that will have predictive value for patients," explains Konstantinos N. Lazaridis, M.D., enterprise IM Clinic director. "It is not an experiment or clinical trial, but rather a consulting service within the Mayo IM Clinic that will offer patients the opportunity to learn how they metabolize certain medications, whether they have a predisposition to some type of cancer or whether they carry a genetic risk of disease that could pass to their children. All these genetic predispositions can be assessed by our genomics predictive services."

Drug-gene alerts already exist on all prescribing tools used at Mayo Clinic. The IM Clinic will integrate drug-gene interactions into the patient electronic record, providing individualized, evidence-based support for clinicians prescribing narcotics and medications for psychiatric and cardiovascular disorders. Additional categories of drug-gene interactions will be added over time.

Dr. Lazaridis notes that, as expected, with progress come ethical challenges. "How a patient metabolizes a particular medication is an important issue, but it doesn't represent a disease state that can be inherited," he says. But if someone carries a gene that potentially causes cancer — that has implications for the entire biological family and adds another layer of complexity."

Counseling will be provided to patients before and after genetic testing to help them better understand the implications of such tests but the effect of findings on both patients and families is unknown.

"Ultimately, it is the patient's decision as to the type of predictive genomics testing to choose. Dr. Lazaridis says. "But the ethical foundation of all genetic testing and counseling services is a deep commitment to the best interest of the patient and a sincere belief that whatever information is given will have value for the future."