This patient had co-administration of several high-level evidence PGx medications for non-cancer therapy, including ondansetron (CYP2D6—CPIC Level A) for nausea, omeprazole (CYP2C19—CPIC Level A, FDA Tier 3) for gastric reflux/ulcers, simvastatin (SLCO1B1—CPIC Level A, FDA Tier 2) for managing high cholesterol, and hydrocodone (CYP2D6—CPIC Level B) for pain management. This evidence concerns the gene CYP2C19 and cancer.