Análisis del protocolo SPIKES desde la perspectiva del paciente oncológico: Estudio prospectivo / Further exploring the SPIKES protocol from the perspective of oncology patients in terms of personality traits

Background: Establishing adequate communication is part of the therapeutic process and of the integral approach to the oncology patient. The SPIKES protocol defines a series of general recommendations aimed at facilitating this process. To date, there is no questionnaire that makes it possible to personalize the communication of bad news in a systematized way. Some studies support the hypothesis that personality influences the communicative modes; therefore, the aim of this work is to try to establish nuances in the SPIKES protocol based on personality traits. Methods: Single-center, observational, prospective, descriptive and correlational study, conducted on a sample of 51 oncology patients based on a personality questionnaire and a communication questionnaire (based on the SPIKES protocol). Results: The scores recorded in all domains of the communication questionnaire were high. There was no significant correlation with the personality questionnaire domains. Conclusions: There are certain needs tending towards universality in the communication of bad news that the SPIKES protocol adequately reflects; it can be considered the gold standard. However, it is not possible to establish nuances in it according to personality traits based on the results of this work. In the strategy phase, attention should be paid to life and family planning in the context of oncologic disease.

Introducción: Establecer una adecuada comunicación forma parte del proceso terapéutico y del abordaje integral del paciente oncológico. El protocolo SPIKES emite una serie de recomendaciones generales destinadas a facilitar este proceso. No existe hasta la fecha un cuestionario que permita personalizar de una manera sistematizada la comunicación de malas noticias. Existen estudios que apoyan la hipótesis de que la personalidad influye en los modos comunicativos. Por ello, el objetivo de este trabajo fue intentar establecer matices en el protocolo SPIKES con base en los rasgos de personalidad. Materiales y métodos: Estudio unicéntrico, observacional, prospectivo, descriptivo y correlacional, realizado sobre una muestra de 51 pacientes oncológicos con base en un cuestionario de personalidad y un cuestionario de comunicación, el cual se basa a su vez en el protocolo SPIKES. Resultados: Las puntuaciones registradas en todos los dominios del cuestionario de comunicación fueron elevadas. Ninguna correlación con los dominios del cuestionario de personalidad resultó significativa. Conclusiones: Existen determinadas necesidades tendentes a la universalidad en torno a la comunicación de malas noticias que el protocolo SPIKES recoge adecuadamente, por lo que puede considerarse el gold standard. No se pueden establecer matices en este cuestionario en función de los rasgos de personalidad con base en los resultados de este trabajo. En la fase de estrategia, conviene prestar atención a la planificación vital y familiar en el seno de la enfermedad oncológica. Palabras Clave: protocolo SPIKES, comunicación de malas noticias, psicooncología, medicina personalizada, relación médico-paciente. ABSTRACT Background:Establishing adequate communication is part of the therapeutic process and of the integral approach to the oncology patient. The SPIKES protocol issues a series of general recommendations aimed at facilitating this process. To date, there is no questionnaire that makes it possible to personalize the communication of bad news in a systematized way. There are studies that support the hypothesis that personality influences the communicative modes. Therefore, the aim of this work is to try to establish nuances in the SPIKES protocol based on personality traits. Methods:Single-center, observational, prospective, descriptive and correlational study, conducted on a sample of 51 oncology patients based on a personality questionnaire and a communication questionnaire (based on the SPIKES protocol). Results: The scores recorded in all domains of the communication questionnaire were high. No correlation with the personality questionnaire Irene Solana López* , Manuel Meilan Uzcategui , Elia Martínez Moreno , Ignacio Juez Martel , David Gutiérrez Abad , Elena Lahoz León , Olga Mateo Rodríguez , Jaime Martínez Moreno , Carlos de Zea Luque , Ana Manuela Martín Fernández de Soignie , Fátima Escalona Martín , Isabel Santana Gómez y Juan Antonio Guerra Martínez Servicio de Oncología Médica, Hospital Universitario de Fuenlabrada, Madrid (Spain)Recibido: 05/02/2024Aceptado: 08/03/2024Publicado: 30/04/2024* Autor de correspondencia: Irene Solana López, irene.solana@salud.madrid.orgArtículo / ArticleISSN: 2661-6653DOI:https://doi.org/10.33821/736Cómo citar: Solana Lopez I, Meilan Uzcategui M, Martinez Moreno E, Juez Martel I, Gutierrez Abad D, Lahoz León E, Mateo Rodríguez O, Martinez Moreno J, de Zea Luque C, Martín Fernández de Soignie AM, Escalona Martín F, Santana Gómez I, Guerra Martinez JA. Análisis del protocolo SPIKES desde la perspectiva del paciente oncológico. Estudio prospectivo basado en cuestionarios. Oncología (Ecuador). 2024;34(1): 4-20. https://doi.org/10.33821/736Further exploring the SPIKES protocol from the perspective of oncology patients in terms of personality traitsProspective questionnaire-based study© 2024 Revista Oncología Ecuador. Publicado por la Sociedad de Lucha Contra el Cáncer, Ecuador. Este es un artículo de acceso abierto publicado bajo una licencia CC BY-NC-SA (http://creativecommons.org/licenses/by-nc-sa/4.0/)

Modelagem farmacocinética/farmacodinâmica do florfenicol para o tratamento da adenite equina por meio da simulação de Monte Carlo / Pharmacokinetic/pharmacodynamic modeling of florfenicol for the treatment of equine adenitis using Monte Carlo simulation

O objetivo deste trabalho foi avaliar a eficácia do florfenicol na dose usualmente empregada em equinos de 22 mg/kg pelas vias intravenosa, intramuscular e oral para o tratamento de adenite equina por Streptococcus equi. subsp. equi, usando a modelagem farmacocinética/farmacodinâmica (PK/PD ­ Pharmacokinetic/Pharmacodynamic) e a simulação de Monte Carlo. Foi realizada uma simulação de Monte Carlo a partir dos parâmetros PK, logo depois, efetuou-se a modelagem PK/PD para determinar as taxas de eficácia do antimicrobiano para o tratamento dessa infecção bacteriana, de acordo com o valor da concentração inibitória mínima (CIM), em um intervalo de CIM de 0,125 ­ 4 µg/mL. Pela via intravenosa, a probabilidade de erradicação bacteriana foi de 100% para CIM até 0,5 µg/mL e efeito bacteriostático com probabilidades de 99% e 80% para CIMs de 2 e 4 µg/mL, respectivamente. Já pelas vias intramuscular e oral a probabilidade de se atingir o índice de erradicação bacteriológica foi de 100% para CIM de até 0,5 µg/mL, contudo, atinge valores de 80% e 81%, respectivamente, para CIM de 1 µg/mL considerando o efeito bactericida (p<0,01). Portanto, através desse estudo é evidenciado a eficácia do florfenicol até a CIM de 0,5 µg/mL para as três vias de administração citadas, entretanto, para CIMs superiores a esse valor, é imprescindível o ajuste da dose farmacológica, evitando falhas na terapêutica e possível resistência microbiana.

The objective of this study was to evaluate the efficacy of florfenicol at the dose usually used in horses of 22 mg/kg by intravenous, intramuscular and oral routes for the treatment of equine adenitis caused by Streptococcus equi. subsp. equi, using Pharmacokinetic/Pharmacodynamic (PK/PD) modeling and Monte Carlo simulation. A Monte Carlo simulation was performed from the PK parameters, then PK/PD modeling was performed to determine the antimicrobial efficacy rates for the treatment of this bacterial infection, according to the minimum inhibitory concentration (MIC) value, in a MIC range of 0.125 - 4 µg/mL. Intravenously, the probability of bacterial eradication was 100% for MICs up to 0.5 µg/mL, and the bacteriostatic effect was 99% and 80% for MICs of 2 and 4 µg/mL, respectively. However, for the intramuscular and oral routes, the probability of reaching the bacteriologic eradication index was 100% for MICs of up to 0.5 µg/mL, however, it reaches values of 80% and 81%, respectively, for MICs of 1 µg/mL considering the bactericidal effect (p<0.01). Therefore, through this study the efficacy of florfenicol is evidenced up to the MIC of 0.5 µg/mL for the three routes of administration cited, however, for MICs higher than this value, it is essential to adjust the pharmacological dose, avoiding failures in therapy and possible microbial resistance.

Modelagem farmacocinética/farmacodinâmica do florfenicol para o tratamento da adenite equina por meio da simulação de Monte Carlo / Pharmacokinetic/pharmacodynamic modeling of florfenicol for the treatment of equine adenitis using Monte Carlo simulation

O objetivo deste trabalho foi avaliar a eficácia do florfenicol na dose usualmente empregada em equinos de 22 mg/kg pelas vias intravenosa, intramuscular e oral para o tratamento de adenite equina por Streptococcus equi. subsp. equi, usando a modelagem farmacocinética/farmacodinâmica (PK/PD – Pharmacokinetic/Pharmacodynamic) e a simulação de Monte Carlo. Foi realizada uma simulação de Monte Carlo a partir dos parâmetros PK, logo depois, efetuou-se a modelagem PK/PD para determinar as taxas de eficácia do antimicrobiano para o tratamento dessa infecção bacteriana, de acordo com o valor da concentração inibitória mínima (CIM), em um intervalo de CIM de 0,125 – 4 μg/mL. Pela via intravenosa, a probabilidade de erradicação bacteriana foi de 100% para CIM até 0,5 μg/mL e efeito bacteriostático com probabilidades de 99% e 80% para CIMs de 2 e 4 μg/mL, respectivamente. Já pelas vias intramuscular e oral a probabilidade de se atingir o índice de erradicação bacteriológica foi de 100% para CIM de até 0,5 μg/mL, contudo, atinge valores de 80% e 81%, respectivamente, para CIM de 1 μg/mL considerando o efeito bactericida (p<0,01). Portanto, através desse estudo é evidenciado a eficácia do florfenicol até a CIM de 0,5 μg/mL para as três vias de administração citadas, entretanto, para CIMs superiores a esse valor, é imprescindível o ajuste da dose farmacológica, evitando falhas na terapêutica e possível resistência microbiana.

The objective of this study was to evaluate the efficacy of florfenicol at the dose usually used in horses of 22 mg/kg by intravenous, intramuscular and oral routes for the treatment of equine adenitis caused by Streptococcus equi. subsp. equi, using Pharmacokinetic/Pharmacodynamic (PK/PD) modeling and Monte Carlo simulation. A Monte Carlo simulation was performed from the PK parameters, then PK/PD modeling was performed to determine the antimicrobial efficacy rates for the treatment of this bacterial infection, according to the minimum inhibitory concentration (MIC) value, in a MIC range of 0.125 - 4 μg/mL. Intravenously, the probability of bacterial eradication was 100% for MICs up to 0.5 μg/mL, and the bacteriostatic effect was 99% and 80% for MICs of 2 and 4 μg/mL, respectively. However, for the intramuscular and oral routes, the probability of reaching the bacteriologic eradication index was 100% for MICs of up to 0.5 μg/mL, however, it reaches values of 80% and 81%, respectively, for MICs of 1 μg/mL considering the bactericidal effect (p<0.01). Therefore, through this study the efficacy of florfenicol is evidenced up to the MIC of 0.5 μg/mL for the three routes of administration cited, however, for MICs higher than this value, it is essential to adjust the pharmacological dose, avoiding failures in therapy and possible microbial resistance.

Melhoria da eficácia do florfenicol no tratamento de pneumonia caprina causada por Pasteurella multocida e Mannheimia haemolytica / Improving the effectiveness of florfenicol in the treatment of caprine pneumonia by Pasteurella multocida and Mannheimia haemolytica

O objetivo do presente trabalho é avaliar a eficácia do tratamento do florfenicol na dose tradicional de 20mg/kg, administrado por via intramuscular e intravenosa, no tratamento de pneumonia por Pasteurella multocida e Mannheimia haemolytica, utilizando o modelamento farmacocinético/farmacodinâmico (PK/PD). Para isso, foi realizada uma simulação de Monte Carlo dos parâmetros farmacocinéticos e farmacodinâmicos, em seguida, efetuou-se o modelamento PK/PD para determinar as taxas de eficácia no tratamento dessa infecção bacteriana, segundo o valor da concentração inibitória mínima (CIM) das bactérias, considerando o intervalo de 0,125 - 4µg/mL. Pela via intramuscular, a probabilidade de se atingir o índice de erradicação bacteriológica foi de 100%, com a CIM de até 0,25µg/mL, efeito bactericida de 100% com CIM até 0,5µg/mL e efeito bacteriostático de 100% com CIM até 1µg/mL. Já pela via intravenosa, a probabilidade de erradicação bacteriológica foi de 100% com CIM até 0,5µg/mL e efeito bacteriostático com probabilidades de 100% e 83% com CIMs de 2 e 4µg/mL, respectivamente. O tratamento com florfenicol na dose de 20mg/kg, via intramuscular, diminuiu de forma significativa para infecções causadas por microrganismos com CIM superior a 0,5µg/mL, porém, pela via intravenosa, os efeitos antibacterianos foram eficientes para CIMs maiores, como as de 2 e 4µg/mL (p < 0.01). Este estudo evidencia a necessidade de se incorporar no protocolo terapêutico o isolamento bacteriológico e levar em consideração a via de administração para que haja a otimização da dose tradicional, a fim de evitar falhas na terapia antimicrobiana, potencializando uma resistência microbiana.

The objective of the present work is to evaluate the efficacy of the treatment of florfenicol in the traditional dose of 20mg/kg administered intramuscularly and intravenously, in the treatment of pneumonia by Pasteurella multocida and Mannheimia haemolytica, using pharmacokinetic / pharmacodynamic modeling (PK/PD). A Monte Carlo simulation of the pharmacokinetic and pharmacodynamic parameters was carried out, and then the PK / PD modeling was performed to determine the efficacy rates in the treatment of this bacterial infection, according to the minimum inhibitory concentration (MIC) value of the bacteria, considering the range of 0.125 - 4µg/mL. Through the intramuscular route, the probability of reaching the bacteriological eradication rate was 100%, with the MIC up to 0.25µg/mL; bactericidal effect of 100% with MIC up to 0.5µg/mL and bacteriostatic effect of 100% with MIC up to 1µg/mL. Intravenously, the probability of bacteriological eradication was 100% with MIC up to 0.5µg/mL and bacteriostatic effect with probabilities of 100% and 83% with MICs of 2 and 4µg/mL, respectively. Treatment with florfenicol at a dose of 20mg/kg, intramuscularly, decreased significantly for infections caused by microorganisms with MIC greater than 0.5µg/mL, however, intravenously the antibacterial effects were efficient for MICs larger than those of 2 and 4µg/mL (p < 0.01). This study highlights the need to incorporate bacteriological isolation into the therapeutic protocol and take into account the route of administration in order to optimize the traditional dose in order to avoid flaws in antimicrobial therapy, enhancing microbial resistance.

Modelagem farmacocinética/farmacodinâmica do florfenicol para o tratamento da adenite equina por meio da simulação de Monte Carlo / Pharmacokinetic/pharmacodynamic modeling of florfenicol for the treatment of equine adenitis using Monte Carlo simulation

O objetivo deste trabalho foi avaliar a eficácia do florfenicol na dose usualmente empregada em equinos de 22 mg/kg pelas vias intravenosa, intramuscular e oral para o tratamento de adenite equina por Streptococcus equi. subsp. equi, usando a modelagem farmacocinética/farmacodinâmica (PK/PD Pharmacokinetic/Pharmacodynamic) e a simulação de Monte Carlo. Foi realizada uma simulação de Monte Carlo a partir dos parâmetros PK, logo depois, efetuou-se a modelagem PK/PD para determinar as taxas de eficácia do antimicrobiano para o tratamento dessa infecção bacteriana, de acordo com o valor da concentração inibitória mínima (CIM), em um intervalo de CIM de 0,125 4 μg/mL. Pela via intravenosa, a probabilidade de erradicação bacteriana foi de 100% para CIM até 0,5 μg/mL e efeito bacteriostático com probabilidades de 99% e 80% para CIMs de 2 e 4 μg/mL, respectivamente. Já pelas vias intramuscular e oral a probabilidade de se atingir o índice de erradicação bacteriológica foi de 100% para CIM de até 0,5 μg/mL, contudo, atinge valores de 80% e 81%, respectivamente, para CIM de 1 μg/mL considerando o efeito bactericida (p<0,01). Portanto, através desse estudo é evidenciado a eficácia do florfenicol até a CIM de 0,5 μg/mL para as três vias de administração citadas, entretanto, para CIMs superiores a esse valor, é imprescindível o ajuste da dose farmacológica, evitando falhas na terapêutica e possível resistência microbiana.(AU)

The objective of this study was to evaluate the efficacy of florfenicol at the dose usually used in horses of 22 mg/kg by intravenous, intramuscular and oral routes for the treatment of equine adenitis caused by Streptococcus equi. subsp. equi, using Pharmacokinetic/Pharmacodynamic (PK/PD) modeling and Monte Carlo simulation. A Monte Carlo simulation was performed from the PK parameters, then PK/PD modeling was performed to determine the antimicrobial efficacy rates for the treatment of this bacterial infection, according to the minimum inhibitory concentration (MIC) value, in a MIC range of 0.125 - 4 μg/mL. Intravenously, the probability of bacterial eradication was 100% for MICs up to 0.5 μg/mL, and the bacteriostatic effect was 99% and 80% for MICs of 2 and 4 μg/mL, respectively. However, for the intramuscular and oral routes, the probability of reaching the bacteriologic eradication index was 100% for MICs of up to 0.5 μg/mL, however, it reaches values of 80% and 81%, respectively, for MICs of 1 μg/mL considering the bactericidal effect (p<0.01). Therefore, through this study the efficacy of florfenicol is evidenced up to the MIC of 0.5 μg/mL for the three routes of administration cited, however, for MICs higher than this value, it is essential to adjust the pharmacological dose, avoiding failures in therapy and possible microbial resistance.(AU)

Small molecules under development for psoriasis: on the road to the individualized therapies.

Psoriasis is an incurable cutaneous illness characterized by the presence of well-delimited reddish plaques and silvery-white dry scales. So far, there is a limited understanding of its pathogenesis, though recent discoveries on the immunological, genetic and molecular aspects of this disease have significantly contributed to the identification of new targets and the development of novel drugs. Despite these advances, many patients are still dissatisfied, so to improve patient satisfaction, reliability, and clinical outcomes, the individualization of the treatments for this disease becomes a necessity. This review summarizes recent findings related to psoriasis pathogenesis and describes new small molecules and targets recently identified as promising for treatments. Additionally, the current status, challenges and the future directions for achieving individualized therapy for this disease and the need for more collaborative studies are discussed. The individualization of treatments for psoriasis, rather than a goal, is analyzed as a process where a dynamic integration between the needs and characteristics of the patients, the pharmacological progress, and the clinical decisions takes place.

Personalized approach to growth hormone replacement in adults

ABSTRACT Growth hormone (GH) deficiency (GHD) in adults is well-characterized and includes abnormal body composition, reduced bone mass, an adverse cardiovascular risk profile, and impaired quality of life. In the early 1990s, it was also shown that patients with hypopituitarism without GH replacement therapy (GHRT) had excess mortality. Today, GHRT has been shown to decrease or reverse the negative effects of GHD. In addition, recent papers have shown that mortality and morbidity are approaching normal in hypopituitary patients with GHD who receive modern endocrine therapy including GHRT. Since the first dose-finding studies, it has been clear that efficacy and side effects differ substantially between patients. Many factors have been suggested as affecting responsiveness, such as sex, age, age at GHD onset, adherence, and GH receptor polymorphisms, with sex and sex steroid replacement having the greatest impact. Therefore, the individual tailoring of GH dose is of great importance to achieve sufficient efficacy without side effects. One group that stands out is women receiving oral estrogen replacement, who needs the highest dose. Serum insulin-like growth factor-1 (IGF-1) is still the most used biochemical biomarker for GH dose titration, although the best serum IGF-1 target is still debated. Patients with GHD due to acromegaly, Cushing's disease, or craniopharyngioma experience similar effects from GHRT as others. Arch Endocrinol Metab. 2019;63(6):592-600

Pharmacogenetics in inflammatory bowel disease: understanding treatment response and personalizing therapeutic strategies.

Inflammatory bowel disease (IBD) is a chronic and heterogeneous disorder characterized by remitting and relapsing periods of activity. Pharmacogenetics refers to the study of the effect of inheritance on individual variation in drug responses. Several drug-related markers in IBD patients have been identified in order to predict the response to medical treatment including biological therapy as well as the reduction of adverse events. In the future, the treatment of IBD should be personalized in its specific profile to provide the most efficacious treatment with lack of adverse events.

Personalized medicine in gastric cancer: Where are we and where are we going?

Despite improvements in adjuvant therapies for gastric cancer in recent years, the disease is characterized by high recurrence rates and a dismal prognosis. The major improvement in the treatment of recurrent or metastatic gastric cancer in recent years has been the incorporation of trastuzumab, a monoclonal antibody that inhibits human epidermal growth factor receptor 2 (HER2) heterodimerization, after the demonstrated predictive value of the overexpression and/or amplification of this receptor. Beyond HER2, other genetic abnormalities have been identified, and these mutations may be targetable by tyrosine kinase inhibitors or monoclonal antibodies. The demonstration of four distinct molecular subtypes of gastric cancer by the Cancer Genome Atlas study highlight the enormous heterogeneity of the disease and its complex interplay between genetic and epigenetic alterations and provide a roadmap to implement genome-guided personalized therapy in gastric cancer. In the present review, we aim to discuss, from a clinical point of view, the genomic landscape of gastric cancer described in recent studies, the therapeutic insights derived from these findings, and the clinical trials that have been conducted and those in progress that take into account tailored therapies for gastric cancer.

La medicina centrada en las personas y la medicina personalizada / Person-centered Medicine and Personalized Medicine

En los últimos años, ante la avalancha tecnológica y de especialización, se ha introducido el concepto de medicina centrada en las personas, que enfatiza en la atención individual de los enfermos como sujetos, con un enfoque holístico, general, no fragmentado, analizando al ser humano en todas sus dimensiones biopsicosociales. Simultáneamente en el tiempo, se ha introducido otro término, el de medicina personalizada o de precisión, que pretende, fundamentalmente, optimizar la prescripción de terapéuticas específicas que se ajusten a las características individuales de cada persona, basadas en la información farmacogenética y farmacogenómica que se disponga, aunque se plantea que también de ella pueden derivarse acciones preventivas y diagnósticas. Estos dos enfoques no son antagónicos, sino que se pueden complementar, en beneficio de los pacientes. Cobra de nuevo actualidad el aserto de que no hay enfermedades, sino enfermos.

In recent years, with the rise of technology and specialization, the concept of person-centered medicine has been introduced. It emphasizes on individual care of patients as subjects using a holistic, general and non-fragmented approach, which considers the human being in all its biopsychosocial dimensions. At the same time, another term has been introduced: the personalized medicine or precision medicine, which primarily aims to optimize the prescription of specific therapies tailored to the individual characteristics of each person, based on available pharmacogenetic and pharmacogenomic information. Although, it is also stated that preventive and diagnostic actions may arise from it. These two approaches are not antagonistic; on the contrary, they can complement each other for the patient’s benefit. The assertion that "there are no diseases, but sick people" becomes topical again.

Personalized medicine and the clinical laboratory / Medicina personalizada e o laboratório clínico

Personalized medicine is the use of biomarkers, most of them molecular markers, for detection of specific genetic traits to guide various approaches for preventing and treating different conditions. The identification of several genes related to heredity, oncology and infectious diseases lead to the detection of genetic polymorphisms that are involved not only in different clinical progression of these diseases but also in variations in treatment response. Currently, it is possible to detect these polymorphisms using several methodologies: detection of single nucleotide polymorphisms using polymerase chain reaction methods; nucleic acid microarray detection; and nucleic acid sequencing with automatized DNA sequencers using Sanger-derived methods and new generation sequencing. Personalized medicine assays are directed towards detecting genetic variations that alter interactions of drugs with targets or the metabolic pathways of drugs (upstream and downstream) and can be utilized for the selection of drug formulations and detect different immunogenicities of the drug. Personalized medicine applications have already been described in different areas of Medicine and allow specific treatment approaches to be applied to each patient and pathology according to the results of these assays. The application of such a protocol demands an increasing interaction between the clinical laboratory and the clinical staff. For its implementation, a coordinated team composed of basic researchers and physicians highly specialized in their areas supported by a highly specialized team of clinical analysts particularly trained in molecular biology assays is necessary.

Medicina personalizada é o uso de biomarcadores, em sua maioria marcadores moleculares, para a detecção de traços genéticos específicos, a fim de orientar diversas abordagens para a prevenção e o tratamento de diferentes doenças. A identificação de vários genes relacionados a doenças hereditárias, oncológicas e infecciosas permite a detecção de polimorfismos genéticos que estão envolvidos em diferentes evoluções clínicas dessas doenças, bem como com variações na resposta ao tratamento. Atualmente, já é possível detectar esses polimorfismos utilizando diversas metodologias: a detecção de polimorfismos de nucleotídeo único pela reação de polimerização em cadeia; a detecção de microarranjos de ácidos nucleicos; e o sequenciamento de ácidos nucleicos com sequenciadores de DNA automatizados usando métodos derivados de sequenciamento Sanger ou de nova geração. Os ensaios de medicina personalizada são dirigidos para detectar variações genéticas que alteram interações de fármacos com alvos ou vias metabólicas de fármacos (anabólicas e catabólicas), podendo ser utilizados para a seleção de formulações farmacêuticas e para detectar diferentes imunogenicidades da droga. As aplicações de medicina personalizada já foram descritas em várias áreas da Medicina e permitem que abordagens de tratamento específicas sejam aplicadas para cada paciente e para cada doença, de acordo com os resultados dos ensaios utilizados. A aplicação de um protocolo desse tipo exige uma relação intensa entre o laboratório e o corpo clínico. Para sua execução, é necessária uma equipe coordenada, composta por investigadores de pesquisa básica e médicos altamente especializados em suas áreas, apoiada por um time bastante especializado de analistas clínicos treinados em testes de biologia molecular.