Page 226 - Personalised medicine of fluoropyrimidines using DPYD pharmacogenetics Carin Lunenburg

Chapter 8
224
pt# Cancer Therapy DPYD
Pro- Initial Toxicity Toxicity Hospital Second dose spective dose (grade specifications admissions? adjustment? screen- adjust- 3–4)?
ing? ment?a
Toxicity Toxicity Hospital (grade specifica- admissions? 3–4)? tions
type
variant
11 Rectal
CAPOX EOX
DPYD*2A DPYD*2A
YES YES NO NOe NO YES
N/A Diarrhoea III
N/A NO
YES (to 60%) YES (to 50%)
NO N/A N/A NO N/A N/A
12 Gastric (met.)
CAP + RT DPYD*2A 14 Rectum N/A c.1236G>A
YES NO YES
Diarrhoea IV + Enteritis + Leukopenia
YES (18 days)
N/A (Quit after TOX in first cycle)
N/A N/A N/A N/A N/A N/A
13 Rectal
YES DNS f N/A
N/A
N/A
N/A
a Initial dose adjustment is the dose adjustment made prior to the first dose of 5-FU or CAP;
b Genotyping was performed on November 7th 2014, while therapy started on November 5th, 2014;
c Patient did not start therapy on its own wish;
d For this patient no dose reduction advice was given because this patient was compound heterozygous (carrying two variants), and it was not possible to predict the remaining DPD enzyme activity with the current information. The advice given was to test the actual DPD enzyme activity with another method;
e Both genotyping and start of therapy where on January 24th, 2014. Therefore the result of the genotyping was not awaited;
f Patient did not start therapy due to renal failure and presence of the DPYD variant.
Abbreviations: RT: radiotherapy; CAPOX: Capecitabine + Oxaliplatin; TPF: Docetaxel + Cisplatin + 5-fluorouracil; CAPOX + BEV: Capecitabine + Oxaliplatin + Bevacizumab; 5-FU: 5-fluorouracil; CAP: Capecitabine; EOX: Epirubicin + Oxaliplatin + Capecitabine; DNS: Did not start; dose recomm.: dose recommendation.