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ICC 2023

Holly West

 Holly West, Speaker at Oncology Conference
University of Birmingham, United Kingdom
Title : DPD mutation testing prior to administration of systemic fluoropyrimidine chemotherapy for cancer treatment.



Fluoropyrimidine based-drugs, such as capecitabine and 5-fluorouracil, are used to treat a variety of cancers.1 Deficiency of dihydropyrimidine dehydrogenase (DPD), an enzyme that catabolises fluoropyrimidines, significantly increases risk of drug toxicity1, therefore dose alteration is recommended.2 Prevalence of DPD deficiency is disputed, but initial estimates suggest 3-5%.3 Guidance from UK Chemotherapy Board (UKCB) recommends that all patients should have a DPD test prior to fluoropyrimidine treatment.4


All patients who receive a first dose of either capecitabine or 5-fluorouracil for systemic cancer treatment between 1st May and 31st August 2022 at Queen Elizabeth Hospital Birmingham (QEHB) have been retrospectively audited (n=163). Data collection and analysis includes: first dose date, DPD testing date and results, first dose alterations and delays awaiting results.


Average time from patient sampling to result reporting was 7.0 days. 9.2% of patients did not have a result available prior to first dose, with 4.9% having no test at all. Despite test results being unavailable, 100% of these patients proceeded with treatment without delay. 6.7% of patients without timely testing subsequently had mutations detected after treatment had been initiated.


Compliance with the UKCB guideline appears poor, with many potential factors influencing this. Therefore, there is a risk of toxicity present which is easily preventable. Findings from this hospital are widely relevant to other oncology centres and emphasise the importance of improving DPD test rates in accordance with national guidance to improve patient care. Various techniques, such as automated reminders for testing when prescribing, may be advantageous for service improvement.



Holly West and Elisa Burke are 4th year medical students at the University of Birmingham (UK). As students with a keen interest in oncology, they hope their data and service improvement suggestions can be applied to oncology centres with a view to improve patient care.