BJMO - volume 9, issue 3, july 2015
A.B.P. van Kuilenburg PhD
Fluoropyrimidines are the cornerstones of all currently applied regimens for the treatment of patients with cancers of the gastrointestinal tract, breast, head and neck. Dihydropyrimidine dehydrogenase plays a pivotal role in the metabolism of 5-fluorouracil and, as such, a deficiency of dihydropyrimidine dehydrogenase has been recognised as an important risk factor, predisposing patients to develop severe 5-fluorouracil associated toxicity. Screening for dihydropyrimidine dehydrogenase deficiency would not only decrease fluoropyrimidine morbidity and enhance patient quality of life but also potentially reduce costs by avoiding toxicity-related hospitalisations. Genotype and phenotype-based dosing recommendations of fluoropyrimidines propose a dose of 50% of the starting dose followed by an increase in dose in patients experiencing no or clinically tolerable toxicity, to ensure efficacy and a dose decrease in patients who do not tolerate the starting dose, to minimize toxicity.
(BELG J MED ONCOL 2015;9(3):95–8)
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