Pharmacogenetics and Metabolism from Science to Implementation in Clinical Practice: The Example of Dihydropyrimidine Dehydrogenase

Title:Pharmacogenetics and Metabolism from Science to Implementation in Clinical Practice: The Example of Dihydropyrimidine Dehydrogenase

Volume: 23 Issue: 14

Author(s): Marzia Del Re*, Giuliana Restante, Antonello Di Paolo, Stefania Crucitta, Eleonora Rofi and Romano Danesi

Affiliation:

• Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126 Pisa,Italy

Keywords: Fluoropyrimidines, DPD, mutations, toxicity.

Abstract: Background: Fluoropyrimidines are widely used in the treatment of solid tumors and remain the backbone of many combination chemotherapy regimens. Despite their clinical benefit, they are associated with frequent gastrointestinal and hematological toxicities, which often lead to treatment discontinuation. Fluoropyrimidines undergo complex anabolic and catabolic biotransformation. Enzymes involved in this pathway include dihydropyrimidine dehydrogenase (DPD), which breaks down 5-FU and its prodrugs. Candidate gene approaches have demonstrated associations between 5-FU treatment outcomes and germline polymorphisms in DPD. The aim of this review is to report and discuss the latest results on fluoropyrimidine pharmacogenetics.

Methods: Literature from PubMed databases and bibliography from retrieved publications have been analyzed according to terms such DPD, DPYD, fluoropyrimdines, polymorphisms, toxicity, pharmacogenetics.

Results: To date, many sequence variations have been identified within DPYD gene, although the majority of these have no functional consequences on enzymatic activity. Nowadays, there is a general agreement on the clinical significance of the importance of DPD deficiency in patients who suffer from severe, life-threatening drug toxicity although preemptive testing is not applied to all patients.

Conclusion: Considering the published literature, clinicians are strongly encouraged to consider testing for DPD poor metabolizer variants as a rational pre-treatment screening for patients candidate to a fluoropyrimidine-based regimens, in order to prevent toxicities and personalise treatments.

Cite this article as:

Re Del Marzia*, Restante Giuliana, Di Paolo Antonello, Crucitta Stefania, Rofi Eleonora and Danesi Romano, Pharmacogenetics and Metabolism from Science to Implementation in Clinical Practice: The Example of Dihydropyrimidine Dehydrogenase, Current Pharmaceutical Design 2017; 23 (14) . https://dx.doi.org/10.2174/1381612823666170125155530

DOI https://dx.doi.org/10.2174/1381612823666170125155530	Print ISSN 1381-6128
Publisher Name Bentham Science Publisher	Online ISSN 1873-4286