Evolution of Dihydropyrimidine Dehydrogenase Diagnostic Testing in a Single Center during an 8-Year Period of Time

Fluoropyrimidine treatment can be optimized based on dihydropyrimidine dehydrogenase (DPD) activity. DPD dysfunction leads to increased exposure to active metabolites, which can result in severe or even fatal toxicity. We provide an overview of 8 years of DPD diagnostic testing (n = 1194). Within th...

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Published in:	Current therapeutic research Vol. 90; pp. 1 - 7
Main Authors:	Coenen, Marieke J.H., Paulussen, Aimée D.C., Breuer, Marc, Lindhout, Martijn, Tserpelis, Demis C.J., Steyls, Anja, Bierau, Jörgen, van den Bosch, Bianca J.C.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-01-2019 Elsevier
Subjects:	Dehydrogenase Dihydropyrimidine genetic variant Fluoropyrimidine Original Research Pharmacogenetics Pharmacogenetics Dihydropyrimidine genetic variant Dehydrogenase Fluoropyrimidine
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Summary:	Fluoropyrimidine treatment can be optimized based on dihydropyrimidine dehydrogenase (DPD) activity. DPD dysfunction leads to increased exposure to active metabolites, which can result in severe or even fatal toxicity. We provide an overview of 8 years of DPD diagnostic testing (n = 1194). Within the study period, our diagnostic test evolved from a single-enzyme measurement using first a radiochemical and then a nonradiochemical assay by ultra HPLC-MS in peripheral blood mononuclear cells with uracil, to a combined enzymatic and genetic test (ie, polymerase chain reaction) followed by Sanger sequence analysis of 4 variants of the DPYD gene (ie, DPYD2A, DPYD13, c.2846A>T, and 1129-5923C>G; allele frequencies 0.58%, 0.03%, 0.29%, and 1.35%, respectively). Patients who have 1 of the 4 variants tested (n = 814) have lower enzyme activity than the overall patient group. The majority of patients with the DPYD2A variant (83%) consistently showed decreased enzyme activity. Only 24 (25.3%) of 95 patients (tested for 4 variants) with low enzyme activity carried a variant. Complete DPYD sequencing in a subgroup with low enzyme activity and without DPYD2A variant (n = 47) revealed 10 genetic variants, of which 4 have not been described previously. We did not observe a strong link between DPYD genotype and enzyme activity. Previous studies have shown that DPD status should be determined before treatment with fluoropyrimidine agents to prevent unnecessary side effects with possible fatal consequences. Our study in combination with literature shows that there is a discrepancy between the DPD enzyme activity and the presence of clinically relevant single nucleotide polymorphisms. At this moment, a combination of a genetic and enzyme test is preferable for diagnostic testing. (Curr Ther Res Clin Exp. 2018; 79:XXX–XXX).
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0011-393X 1879-0313
DOI:	10.1016/j.curtheres.2018.10.001