Each year, about 600 children in the Netherlands are diagnosed with cancer. At the Princess Máxima Center, they receive a full DNA analysis of both the tumor cells and the healthy cells at diagnosis. In the healthy cells, the so-called germline DNA is analyzed. This is the DNA a child carries throughout life.
National initiative
The data from the DNA analysis are also used for pharmacogenetic analyses, which look at how a child’s genetic profile can predict the effect and possible side effects of medicines. This pharmacogenetic information is summarized in the DNA Medication Card, which is currently being developed.
Dr. Meta Diekstra is a hospital pharmacist and clinical pharmacologist in the pharmacy of the Princess Máxima Center. She is also a postdoctoral researcher in the Huitema group. She is involved in the DNA Medication Card and explains: ‘All results included in the DNA Medication Card are based on scientific evidence and guidelines. They help physicians and pharmacists choose medicines that are safer and more effective for each child. This allows us to adjust the dose of a medicine before treatment starts or choose a more suitable medicine in time. The DNA Medication Card can also be used by other hospitals in the region, by general practitioners and by pharmacists.’
The card, which is expected to become available at the Máxima Center at the end of 2026, is being developed as part of a national initiative started by Amsterdam UMC, Leiden University Medical Center (LUMC) and Maasstad Hospital in Rotterdam. The Princess Máxima Center joined this initiative earlier this year.
Looking ahead
Dr. Lidwien Hanff, head of the pharmacy at the Máxima Center, sees the DNA Medication Card as an important step toward personalized care: ‘What makes this development so special is that children will benefit from it throughout their lives. If medicines are needed later, for example when someone becomes ill, healthcare professionals can quickly see which medicine and which dose best match that person’s DNA.’
Pharmacogenetics in practice
The pharmacy at the Máxima Center currently gives personalized medication advice based on DNA analysis for certain chemotherapies, pain medication, anti-epileptic drugs, antifungal medicines, acid-reducing medicines, blood thinners and medicines that suppress the immune system.
Several departments at the Máxima Center work together to move from DNA analysis to pharmacogenetic insights. The Laboratory for Pediatric Oncology provides the DNA data. The bioinformaticians of the Big Data Core Facility process the data and translate them into a practical report. The pharmacist interprets this report and documents it in the patient file. The pharmacist then checks whether a dose adjustment is needed based on the genetic profile and the current medication. If necessary, the pharmacist calls the pediatric oncologist with the updated advice. In the future, when a new medicine is prescribed, the computer system will always check the genetic profile. If a dose adjustment is needed, a notification appears in the patient file. Diekstra: ‘In this way, we bring all knowledge together to offer children the best possible treatment, with the best possible quality of life. And because each person’s DNA is fixed, every child can benefit from this information throughout life.’
The development of the DNA Medication Card at the Princess Máxima Center is part of the project ‘Sustainable integration of pharmacogenetics in pediatric oncology’. This project is financially supported by the Princess Máxima Center Foundation and Stichting Universitas.