CPIC Guideline Update: DPYD Genotyping Before Fluoropyrimidine Chemotherapy to Prevent Severe Toxicity
This updated CPIC guideline provides recommendations for adjusting 5-fluorouracil and capecitabine doses based on DPYD genotype to prevent life-threatening toxicity in patients with reduced dihydropyrimidine dehydrogenase activity. Four key DPYD variants are addressed with specific dose reduction or avoidance recommendations. For oncology laboratories, DPYD testing before fluoropyrimidine initiation represents one of the most impactful pharmacogenomic interventions, now increasingly mandated in European clinical practice.
The original study
Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 Update.
- Authors
- Amstutz U, Henricks LM, Offer SM, Barbarino J, Schellens JHM, Swen JJ, et al.
- Journal
- Clinical pharmacology and therapeutics
- Type
- Journal Article, Practice Guideline, Systematic Review
- PMID
- 29152729
Original abstract
The purpose of this guideline is to provide information for the interpretation of clinical dihydropyrimidine dehydrogenase (DPYD) genotype tests so that the results can be used to guide dosing of fluoropyrimidines (5-fluorouracil and capecitabine). Detailed guidelines for the use of fluoropyrimidines, their clinical pharmacology, as well as analyses of cost-effectiveness are beyond the scope of this document. The Clinical Pharmacogenetics Implementation Consortium (CPIC® ) guidelines consider the situation of patients for which genotype data are already available (updates available at https://cpicpgx.org/guidelines/guideline-for-fluoropyrimidines-and-dpyd/).