ArticleInternational journal of cancer2026
DPYD and UGT1A1 Genotype-Based Dosing for Fluoropyrimidines and Irinotecan Chemotherapy: Variant-Specific Impact on Treatment Intensity and Toxicity.
Article in International journal of cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
DPYD and UGT1A1 variants significantly affect fluoropyrimidines and irinotecan safety. While genotype-driven dosing reduces severe toxicity, the impact of individual variants remains incompletely investigated. This retrospective cohort study includes 178 cancer patients with a matched actionable DPYD and/or UGT1A1 genotypes, defined by the presence of guideline-recommended variants (DPYD: rs3918290, DPYD*2A, c.1905+1G>A; rs55886062, DPYD*13, c.1679T>G; rs67376798, c.2846A>T; rs56038477, c.1236G>A (HapB3); UGT1A1: rs8175347, UGT1A1*28/*37 and rs4148323, UGT1A1*6, c.211G>A), and treated with fluoropyrimidines and/or irinotecan. Patients were classified into standard-of-care (posttreatment genotyping; n = 97) or genotype-driven group (pretreatment genotyping with DPWG-driven dosing; n = 81). Clinically relevant toxicity and relative dose intensity (RDI), a proxy for drug exposure, were evaluated by genotype. Genotype-driven dosing significantly reduced overall clinically relevant toxicity (16.0% vs. 43.3%; p < 0.001). Among DPYD c.1905+1G>A heterozygous carriers, clinically relevant toxicities occurred only within standard-of-care (61.5% vs. 0%, p = 0.007), with lower RDI despite full starting dose (41% [IQR 13-62] vs. 48% [IQR 46-50], p = 0.425). In DPYD c.2846A>T heterozygous carriers, standard-of-care had slightly higher RDI (63% [IQR 54-80] vs. 50% [IQR 43-50], p = 0.007) but doubled toxicity rate (27% vs. 67%, p = 0.092). Conversely, DPYD c.1236G>A (HapB3) heterozygous carriers experienced similarly low toxicity rates (23.7 vs. 13.2, p = 0.375), but genotype-driven dosing markedly reduced RDI (50% [IQR 43-55] vs. 82% [IQR 63-92], p < 0.001). In UGT1A1*28 homozygous carriers, genotype-driven dosing reduced toxicity (21.1% vs. 45.7%, p = 0.086) while preserving comparable RDI (58% [IQR 50-69] vs. 61% [IQR 41-76], p = 0.906). These findings suggest uniform genotype-based strategies may not fully capture variant-specific effects, particularly for DPYD c.1236G>A (HapB3), supporting more flexible dosing approaches.
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