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Near Miss or Standard of Care? DPYD Screening for Cancer Patients Receiving Fluorouracil
5-fluorouracil (5-FU) and its pro-drug capecitabine are widely used anticancer agents. Most 5-FU catabolism is dependent on dihydropyrimidine dehydrogenase (DPD) encoded by the DPYD gene, and DPYD variants that reduce DPD function increase 5-FU toxicity. Most DPD deficient patients are heterozygous...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816174/ https://www.ncbi.nlm.nih.gov/pubmed/33704179 http://dx.doi.org/10.3390/curroncol28010012 |
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author | Winquist, Lauren E. Sanatani, Michael Kim, Richard B. Winquist, Eric |
author_facet | Winquist, Lauren E. Sanatani, Michael Kim, Richard B. Winquist, Eric |
author_sort | Winquist, Lauren E. |
collection | PubMed |
description | 5-fluorouracil (5-FU) and its pro-drug capecitabine are widely used anticancer agents. Most 5-FU catabolism is dependent on dihydropyrimidine dehydrogenase (DPD) encoded by the DPYD gene, and DPYD variants that reduce DPD function increase 5-FU toxicity. Most DPD deficient patients are heterozygous and can be treated with reduced 5-FU dosing. We describe a patient with a genotype associated with near complete absence of DPD function, and severe and likely fatal toxicity with 5-FU treatment. The patient was treated effectively with alternative systemic therapy. Routine pretreatment DPYD genotyping is recommended by the European Medicines Agency, and guidelines for use of 5-FU in DPD deficient patients are available. However, outside the province of Quebec, routine pretreatment screening for DPD deficiency remains unavailable in Canada. It is likely our patient would have died from 5-FU toxicity under the current standard of care, but instead provides an example of the potential benefit of DPYD screening on patient outcomes. |
format | Online Article Text |
id | pubmed-7816174 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-78161742021-01-27 Near Miss or Standard of Care? DPYD Screening for Cancer Patients Receiving Fluorouracil Winquist, Lauren E. Sanatani, Michael Kim, Richard B. Winquist, Eric Curr Oncol Case Report 5-fluorouracil (5-FU) and its pro-drug capecitabine are widely used anticancer agents. Most 5-FU catabolism is dependent on dihydropyrimidine dehydrogenase (DPD) encoded by the DPYD gene, and DPYD variants that reduce DPD function increase 5-FU toxicity. Most DPD deficient patients are heterozygous and can be treated with reduced 5-FU dosing. We describe a patient with a genotype associated with near complete absence of DPD function, and severe and likely fatal toxicity with 5-FU treatment. The patient was treated effectively with alternative systemic therapy. Routine pretreatment DPYD genotyping is recommended by the European Medicines Agency, and guidelines for use of 5-FU in DPD deficient patients are available. However, outside the province of Quebec, routine pretreatment screening for DPD deficiency remains unavailable in Canada. It is likely our patient would have died from 5-FU toxicity under the current standard of care, but instead provides an example of the potential benefit of DPYD screening on patient outcomes. MDPI 2020-12-18 /pmc/articles/PMC7816174/ /pubmed/33704179 http://dx.doi.org/10.3390/curroncol28010012 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Case Report Winquist, Lauren E. Sanatani, Michael Kim, Richard B. Winquist, Eric Near Miss or Standard of Care? DPYD Screening for Cancer Patients Receiving Fluorouracil |
title | Near Miss or Standard of Care? DPYD Screening for Cancer Patients Receiving Fluorouracil |
title_full | Near Miss or Standard of Care? DPYD Screening for Cancer Patients Receiving Fluorouracil |
title_fullStr | Near Miss or Standard of Care? DPYD Screening for Cancer Patients Receiving Fluorouracil |
title_full_unstemmed | Near Miss or Standard of Care? DPYD Screening for Cancer Patients Receiving Fluorouracil |
title_short | Near Miss or Standard of Care? DPYD Screening for Cancer Patients Receiving Fluorouracil |
title_sort | near miss or standard of care? dpyd screening for cancer patients receiving fluorouracil |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816174/ https://www.ncbi.nlm.nih.gov/pubmed/33704179 http://dx.doi.org/10.3390/curroncol28010012 |
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