US authorities have not required or recommended testing. There are, however, a few institutes in the US that have started testing patients.
Institutes/MDs with at least partial implementation:
- Norris Cotton Center at Dartmouth Hitchcock
- Atrium Health, Charlotte NC
- University of Michigan
- Sanford Imagenetics, South Dakota
- Dr. Rashid, Toledo Clinic Cancer Centers
- Dr. Kasi, University of Iowa
- University of Colorado
- The Christ Hospital Cincinnati, Ohio
- Yale Cancer Center
- Dana Farber Cancer Institute, Boston MA
St Jude’s Children Hospital, Memphis TN
Ochsner Health, New Orleans LA
Indiana University, Bloomington IN
St Elizabeth Healthcare, Edgewood KY (Cincinnati region)
Northshore – Edward-Elmhurst Health, Evanston IL
Institutes implementing within prospective clinical trial:
- University of Pennsylvania Perelman School of Medicine
- University of Chicago
- Moffitt Cancer Center, Tampa FL
These countries/provinces are leading the way in patient care by either Recommending or Requiring testing for DPD/DPYD prior to the start of treatment
- France first mandated the screening of patients in 2019. It chose to require phenotyping (not genetic testing) to determine the activity level of the DPD enzyme in the blood stream.
- Quebec recommends genetic testing prior to chemotherapy using fluoropyrimidines.
- The European Medicines Agency (EMA), recommended screening in 2020. The screening may employ pheno or genotyping. The EMA also recommended the use of reduced dosing for DPD deficient patients and therapeutic drug monitoring following treatment so dosing may be adjusted according to a patient’s ability to tolerate the drug. See: https://www.ema.europa.eu/en/medicines/dhpc/5-fluorouracil-iv-capecitabine-tegafur-containing-products-pre-treatment-testing-identify-dpd
- The United Kingdom’s Medicines and Healthcare Products and Regulatory Agency indicates that “All patients should be tested for DPD deficiency before initiation to minimise the risk of these reactions”. See: https://www.gov.uk/drug-safety-update/5-fluorouracil-intravenous-capecitabine-tegafur-dpd-testing-recommended-before-initiation-to-identify-patients-at-increased-risk-of-severe-and-fatal-toxicity
- Similarly, authorities in the Netherlands, Germany, Switzerland and Austria recommend pre-screening.
- In addition, the Peter MacCallum Cancer Centre in Australia follows the CPIC guidelines for testing/treating all patients preparing to receive fluoropyrimidine chemotherapy.