Using pharmacogenomics to make chemotherapy safer.
What is DPYD testing?
Dihydropyrimidine dehydrogenase (DPYD) testing looks for variants people carry that mean they cannot breakdown a common form of chemotherapy drug (fluoropyrimidines) that could potentially lead to severe side effects and in rare cases it can be fatal.
This project aims to ensure that DPYD testing is equitable, standardised and optimised across England and to ensure the testing itself is clinically effective by looking for other potential variants.
DPYD variation testing can highlight the 3-5% of patients deficient in the DPD enzyme which plays a key role in the metabolism of fluoropyrimidines class of drugs (e.g. 5-fluorouracil and capecitabine).
What are we doing?
Transformation work to map how this test is used in practice has confirmed regional adoption and identified areas for improvement.
This will be achieved by auditing all hospitals where these chemotherapy drugs are used to ensure the right number of tests and dosage of the drugs are being prescribed, explore other potential variants that could be prevalent in other ethnic communities and to raise awareness.
115 hospitals across England refer patients for testing, with NHS Genomic Laboratory Hubs (GLHs) processing approximately 3,100 samples every month, with 198 patients found to carry a single variant or 2 variants each month (up to November 2021).
Ensuring all patients who carry these variants are identified could reduce the toxic reactions among patients and widening the search for new variants could help ensure testing is effective for all communities.
Having established that DPYD testing is widely used, we are looking at improving how laboratory and prescribing systems can better share genomic test results. We are also looking to understand how oncology teams are using the pharmacgoenomic test for DPD variation.
Who are we working with?
- Regional Cancer Alliances (East Midlands and East of England)
- NHS North West and NHS South East GMS Alliances (national project leads)
One of these areas for improvement is in how results are provided and future work is looking at the structure and flow of pharmacogenomics tests results, aiming to deliver results to clinicians within prescribing systems.
Meet our team
Paul Selby, East GMSA Pharmacy Lead (firstname.lastname@example.org)