TY - JOUR
T1 - Evolution of Dihydropyrimidine Dehydrogenase Diagnostic Testing in a Single Center during an 8-Year Period of Time
AU - Coenen, Marieke J. H.
AU - Paulussen, Aimee D. C.
AU - Breuer, Marc
AU - Lindhout, Martijn
AU - Tserpelis, Demis C. J.
AU - Steyls, Anja
AU - Bierau, Jorgen
AU - van den Bosch, Bianca J. C.
N1 - Publisher Copyright:
© 2018 The Authors
PY - 2019
Y1 - 2019
N2 - Objective: 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.Methods: We provide an overview of 8 years of DPD diagnostic testing (n=1194).Results: 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, DPYD*2A, DPYD*13, 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 DPYD*2A 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 DPYD*2A 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.Conclusions: 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). (C) 2018 The Authors. Published by Elsevier Inc.
AB - Objective: 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.Methods: We provide an overview of 8 years of DPD diagnostic testing (n=1194).Results: 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, DPYD*2A, DPYD*13, 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 DPYD*2A 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 DPYD*2A 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.Conclusions: 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). (C) 2018 The Authors. Published by Elsevier Inc.
KW - Dehydrogenase
KW - Dihydropyrimidine genetic variant
KW - Fluoropyrimidine
KW - Pharmacogenetics
KW - CLINICAL-RELEVANCE
KW - DPYD VARIANTS
KW - 5-FLUOROURACIL
KW - GENE
KW - TOXICITY
KW - GENOTYPE
KW - OXALIPLATIN
KW - DEFICIENCY
KW - EXPRESSION
KW - MUTATIONS
U2 - 10.1016/j.curtheres.2018.10.001
DO - 10.1016/j.curtheres.2018.10.001
M3 - Article
C2 - 30510603
SN - 0011-393X
VL - 90
SP - 1
EP - 7
JO - Current Therapeutic Research-Clinical and Experimental
JF - Current Therapeutic Research-Clinical and Experimental
ER -