Expanding Precision Medicine in Oncology: Practical Strategies for Pharmacists and Health Systems

In this interview with Pharmacy Times at Oncology Pharmacists Connect in Austin, TX, Sonia Amin Thomas, PharmD, BCOP, AFMCP, INHC, Vice Chair, Professor of Pharmacy Practice, Clinical Oncology Pharmacist, Integrative Nutrition Health Coach, PCOM School of Pharmacy Georgia, and NGOC at Wellstar North Fulton Hospital, discusses the growing role of oncology pharmacists in precision medicine and pharmacogenomics. She highlights common challenges clinicians face when interpreting increasingly complex molecular testing reports, identifying clinically actionable variants, and navigating available resources to support treatment decisions. Thomas also reviews key institutional barriers to implementing precision medicine programs, including education gaps, testing turnaround times, report accessibility, and infrastructure limitations, emphasizing the importance of establishing dedicated champions and multidisciplinary support.

Pharmacy Times: Many oncology pharmacists recognize the value of precision medicine but may feel less confident interpreting increasingly complex molecular and biomarker data. What knowledge gaps or areas of uncertainty do you encounter most frequently, and how can pharmacists build competency in these areas?

Sonia Amin Thomas, PharmD, BCOP, AFMCP, INHC: Thanks for the question. I think many of the challenges involve reading molecular reports and determining how to interpret the findings, including identifying which variants or subtypes are most clinically relevant. That can be particularly difficult when deciding which resources to use. Should we refer to CPIC guidelines? Should we use OncoKB? Should we rely on information provided by the company that generated the report? Knowing where to find reliable and actionable information is often one of the biggest challenges.

My biggest recommendation is to utilize several different resources rather than relying on a single source. For pharmacists who are new to precision medicine, the ASHP pharmacogenomics certificate program is a good place to start. It provides a strong foundational understanding and can help build baseline knowledge in this area.

Beyond that, there are a variety of online educational modules available through professional organizations, companies, and individuals who focus on precision oncology. Many of these resources provide practical guidance on how to interpret molecular testing results and apply them in clinical practice.

I also recommend reviewing the growing body of review articles available in the literature. One important consideration is that molecular testing and precision medicine can vary significantly by cancer type. As a result, understanding how biomarkers are used within a specific disease state is critical.

Overall, my recommendation is to start with foundational educational resources and then build upon that knowledge through disease-specific reviews, educational modules, and trusted clinical reference tools.

Pharmacy Times: Your workshop focuses on integrating precision medicine into clinical workflows. What are some of the most common institutional barriers you've seen—whether related to staffing, technology, education, or resources—and how have successful programs overcome them?

Amin Thomas: I think there are several institutional barriers to implementing pharmacogenomics and precision medicine more broadly. One of the biggest challenges is education. Both physicians and pharmacists need to stay current and be knowledgeable about how to interpret molecular and pharmacogenomic reports and determine what information is clinically actionable.

The second major challenge is accessibility. Many pharmacogenomic tests require 2 to 3 weeks for results to be returned, which can be a significant delay when treatment decisions need to be made quickly. Waiting for those results before initiating or modifying therapy can be difficult in clinical practice.

Another accessibility challenge involves the reports themselves. Molecular and pharmacogenomic reports are not always easily available within the electronic health record. In some cases, they are uploaded separately or stored in locations that are not readily accessible to all members of the care team. As a result, pharmacists may not always be able to review the reports directly, which can create additional barriers to implementation.

Addressing these challenges requires strong institutional infrastructure. Developing policies and workflows is important, but equally important is identifying a champion to help lead implementation efforts. Ideally, this individual should understand both the operational and clinical aspects of pharmacogenomics. They can help determine what findings are clinically actionable versus what information may be primarily educational in nature.

Ultimately, one of the most effective starting points is designating someone within the department who has a particular interest in or expertise in pharmacogenomics and can help coordinate education, implementation, and ongoing clinical integration efforts.

Pharmacy Times: As genomic testing becomes more routine in oncology care, how do you envision the pharmacist's role evolving in areas such as biomarker interpretation, treatment selection, and communication with the broader multidisciplinary care team?

Amin Thomas: Yes, I definitely believe that the role of the oncology pharmacist will continue to expand within precision medicine. It may take time to determine whether these responsibilities will become part of the role of all oncology pharmacists or whether they will primarily be managed by designated specialists with expertise in precision medicine. At this point, I think that remains to be seen.

Regardless of how the field evolves, I believe it is important for all oncology pharmacists to develop a foundational understanding of precision medicine. Even basic knowledge related to interpreting molecular reports, understanding biomarkers and subtypes, and recognizing their clinical significance can be extremely valuable in practice.

I also think there is a growing opportunity for pharmacists to participate in molecular tumor boards. Including a pharmacist on these multidisciplinary teams can help ensure that medication-related considerations are incorporated into discussions about molecular findings and treatment recommendations.

For many institutions, establishing a molecular tumor board may be an effective way to begin integrating precision medicine into clinical practice. It can also help engage physician champions and foster the multidisciplinary collaboration needed to successfully implement and expand precision oncology programs.

Pharmacy Times: For oncology pharmacists practicing in community settings or smaller institutions with limited precision medicine infrastructure, what practical and scalable steps can they take today to begin expanding precision medicine services for their patients?

Amin Thomas: That is a great question because it reflects the situation many smaller community institutions face, including my own.

One of the most important first steps is identifying a designated champion within the organization. This individual can help lead implementation efforts, educate themselves on precision medicine and molecular testing, and serve as a resource for the rest of the team. Even if that person is not able to become a deep subject matter expert immediately, they can help coordinate educational opportunities and bring in representatives from testing companies or other experts to provide training and support for staff.

Another important step is developing a structured implementation plan with a realistic timeline. Having defined goals and milestones can help keep the process organized and ensure that progress continues over time.

It is also critical to identify a physician champion who can partner in these efforts. Physician support is essential for successful implementation, particularly in smaller community settings where resources may be more limited. Having a physician advocate who understands the value of molecular testing and precision medicine can help drive adoption and encourage broader engagement across the care team.

One of the challenges in community practice is that pharmacists are often expected to have knowledge across many different cancer types rather than focusing on a single disease state. Because of this, strong collaboration between pharmacists, physicians, and other members of the care team becomes even more important.

Ultimately, success in implementing precision medicine at smaller institutions often begins with identifying dedicated champions, establishing a clear plan, investing in education, and fostering strong multidisciplinary support throughout the process.