Authors: CATC Lunenburg JJ Swen HJ Guchelaar H Gelderblom
Publish Date: 2016/12/27
Volume: 48, Issue: 1, Pages: 117-118
Abstract
With great interest we have read the recent paper of Kodali et al 1 describing a case report of a patient with rectal cancer treated with neoadjuvant chemoradiation capecitabine who experienced severe toxicity grade 4 including hospitalization upon this standard treatment The patient tested positive for the DPYD2A c1905 + 1G A IVS14 + 1G A rs3918290 variant leading to reduced activity of the dihydropyrimidine dehydrogenase DPD enzyme the key enzyme for fluoropyrimidine metabolism 2 The patient recovered completely and finished radiotherapy without capecitabine Hereafter the patient was treated with a FOLFOX6 regimen in a personalized dose 25 5FU 50 leucovorin without bolus 5FUWe disagree with the authors’ recommendation to await potentially lethal toxicity instead of pretreatment DPYDscreening Instead the authors state that in case of observed toxicity patients can be tested for DPD deficiency and customized dose reductions
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