The Urgent Need for Universal DPYD Testing Before Chemotherapy in the US
TL/DR –
One in 20 people carry a gene change in DPYD, which can cause severe illness or death if they undergo certain chemotherapies. This is estimated to cause 700-1,400 deaths annually from 5-FU toxicity in the U.S. Advocates are pushing for universal DPYD testing before administering chemotherapy, a policy already adopted in countries like the EU, UK, Canada, Australia, and Zimbabwe.
Genetic Variant and Chemotherapy Reactions
1 in 20 people possess a modification in a gene called DPYD, which can cause severe reactions to certain types of chemotherapy like fluorouracil (5-FU) or capecitabine (Xeloda or CAPE). It’s estimated that 700-1,400 patients die of 5-FU toxicity annually in the US.
DPYD’s Impact on Individuals
Karen Merritt’s mother, a carrier of a DPYD mutation, succumbed not to her anal cancer, but to the chemotherapy treatment’s side effects. This unfortunate event spearheaded Karen’s founding of Advocates for Universal DPD/DPYD Testing.
The Push for Universal DPYD Testing
Advocates for Universal DPD/DPYD Testing urges the US to follow other countries in mandating DPYD testing before administering 5-FU. DPYD testing, costing around $300, pales in comparison to the treatment cost for DPYD-toxicity and can reduce overall medical system costs.
Why the Delay in the US?
The reluctance to universally recommend DPYD testing, according to Dr. John Strickler, comes from the complexity and variability of pharmacogenetic testing. Not all insurance companies cover the testing, and it may delay the start of chemotherapy.
Existing DPYD Testing Initiatives
Some institutions like Duke now have universal DPYD testing in place. Dr. Dan Flora of St. Elizabeth Healthcare in Kentucky explains that they have integrated pharmacogenetics testing, including DPYD, into their system. The system prompts testing before chemotherapy drug prescription.
Changing the Status Quo
For DPYD testing to become standard in the US, medical professionals call for a transformation in NCCN recommendations. Dr. Scott Kapoor believes changing these recommendations would quicken the adoption of universal DPYD testing. Another approach suggested by Dr. Strickler is for insurance companies to deny chemotherapy payment without conducting DPYD testing.
Embracing Universal DPYD Testing
Given the clear data on DPYD, it’s crucial for national guideline changes that recommend universal DPYD testing. This shift benefits health systems and patients alike, potentially saving lives and reducing adverse chemotherapy reactions.
Suggested further reading: DPYD testing and chemotherapy.
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