Pre-treatment DPYD genotyping of a panel of 4-single nucleotide polymorphism (SNP) including DPYD*2A, DPYD*13, c.2846A$>$T and c.1236A$>$G-HapB3, has been strongly recommended by the current pharmacogenetics guidelines in order to avoid severe fluoropyrimidine (FL)-related toxicity. However, translation to clinical practice is still lagging behind. This requires a better definition of the relationship between genetic variants of DPYD and dose-limiting toxicities (DLTs) and development of new methods to investigate the effect of DPYD variants, such as the DPYD activity score. The aim of the current study was to support the clinical implementation of DPYD genetic testing, by assessing the relationship between DPYD variants in the 4-SNP panel and the risk to develop DLTs and by stratifying patients according to the DPYD gene activity score (GAS) model. (GAS $=$ 1.0 if carriers of one DPYD*2A or DPYD*13 alleles and GAS $=$ 1.5, if carriers of one c.2846A$>$T or c.1236G$>$A-HapB3 allele. Non-carriers GAS $=$ 2.0). A retrospective population of 763 colorectal cancer patients treated with FL-based chemotherapy, was selected and genotyped$.$ Patients carrying at least one decreased function DPYD variant in the 4-SNP panel, displayed a significant association with the risk of developing DLT ($i.e.$ grade $\geq $ 3 non-hematological toxicity or grade $\geq $ 4 hematological toxicity) either within the first three cycles of chemotherapy (OR$=$ 2.7, 95% CI $=$ 1.33-5.41) or during the entire course of treatment (OR $=$ 2.7, 95% CI $=$ 1.42-5.04). Patients' GAS was found to better define the risk of DLT for both acute (GAS $=$ 1.5, OR $=$ 1.80, 95% CI $=$ 0.78-4.15 and GAS $=$ 1.0, OR $=$ 10.12, 95% CI $=$ 2.55-40.20) and total toxicity (GAS $=$ 1.5, OR $=$ 2.08, 95% CI $=$ 1.02-4.27 and GAS $=$ 1, OR $=$ 7.09, 95% CI $=$ 1.69-29.65). In conclusion, the present study demonstrates that the DPYD 4-SNP panel and the associated GAS can predict the occurrence of DLT related to treatment with FL. These findings further support the implementation of pre-emptive DPYD genotyping in the routine clinical practice.
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Research Article
DPYD Gene Activity Score Predicts Dose-Limiting Toxicity in Fluoropyrimidine-Treated Colorectal Cancer Patients
Dalle Fratte Chiara1, Polesel Jerry2, Roncato Rossana1, De Mattia Elena1, Ecca Fabrizio1, Bignucolo Alessia1, Garziera Marica1, Dreussi Eva1, Palazzari Elisa3, Buonadonna Angela4, Guardascione Michela1, Berretta Massimiliano4, Foltran Luisa5, Sartor Franca1, D'Andrea Mario6, Favaretto Adolfo7, Mini Enrico8, Nobili Stefania9, De Paoli Antonino3, Toffoli Giuseppe1,*, Cecchin Erika1
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1
Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (IRCCS), via F. Gallini 2, 33081 Aviano (PN), Italy
2
Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (IRCCS), via F. Gallini 2, 33081 Aviano (PN), Italy
3
Radiation Oncology Unit, Centro di Riferimento Oncologico di Aviano (IRCCS), via F. Gallini 2, 33081 Aviano (PN), Italy
4
Department of MedicalOncology, Centro di Riferimento Oncologico di Aviano (IRCCS), via F. Gallini 2, 33081 Aviano (PN), Italy
5
Department of Oncology, Azienda Ospedaliera Santa Maria degli Angeli, 33170 Pordenone (PN), Italy
6
Medical Oncology Unit, San Filippo Neri Hospital, Piazza Di S. Maria Della Pietà, CAP Rome (RO), Italy
7
Medical Oncology Unit, Ospedale Cà Foncello, Piazzale Ospedale 1, 31100 Treviso (TV), Italy
8
Department of Experimental and Clinical Medicine, University of Florence, Piazza di San Marco 4, 50121 Florence (FI), Italy
9
Department of Health Sciences, University of Florence, Piazza di San Marco 4, 50121 Florence (FI), Italy
* gtoffoli@cro.it (Toffoli Giuseppe)
J. Mol. Clin. Med. 2018, 1(3), 143–150;
https://doi.org/10.31083/j.jmcm.2018.03.003
Submitted: 6 August 2018 | Revised: 21 August 2018 | Accepted: 22 August 2018 | Published: 20 September 2018
Abstract
Keywords
Fluoropyrimidine
Dihydropyrimidine dehydrogenase
Drug-related toxicity
Chemotherapy
Pharmacogenetics
Colorectal cancer
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