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Considerations for the clinical implementation of DPYD and UGT1A1-guided chemotherapy

Mary-Pearl Ojukwu1, Carlos Vegas1, Emily J Cicali1

  • 1Center for Pharmacogenomics and Precision Medicine and Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.

Pharmacogenomics
|June 6, 2026
PubMed

Insights

Pharmacogenetic (PGx) testing for DPYD and UGT1A1 is crucial for reducing chemotherapy toxicity. Implementation strategies are vital for widespread adoption, with cost-effectiveness and workflow integration being key considerations.

Area of Science:

  • Pharmacogenomics
  • Clinical Chemistry
  • Translational Medicine

Background:

  • DPYD and UGT1A1 pharmacogenetic (PGx) testing reduces fluoropyrimidine and irinotecan toxicity, respectively.
  • Regulatory bodies (FDA) and professional organizations (NCCN) now recommend DPYD testing before fluoropyrimidine therapy.
  • Growing interest in PGx testing necessitates guidance on implementation strategies.

Purpose of the Study:

  • To review conclusions from DPYD and/or UGT1A1 implementation initiatives.
  • To identify key takeaways regarding perspectives, workflow, cost, and supportive care.
  • To provide guidance for institutions implementing PGx testing.

Main Methods:

  • Systematic review of 32 articles on DPYD and/or UGT1A1 implementation initiatives.
  • Analysis of data related to perspectives, workflow, cost, and supportive care.
  • Synthesis of key considerations and takeaways from implementation studies.

Main Results:

  • Positive perspectives towards PGx testing, but barriers like turnaround time and cost exist.
  • Varied workflow integration across institutions, necessitating clear duty delineation.
  • Real-world data and modeling confirm cost-effectiveness of DPYD and UGT1A1 testing.
  • Underutilization of PGx testing for supportive care medications presents an opportunity for panel-based approaches.

Conclusions:

  • Implementation of DPYD and UGT1A1 PGx testing is feasible and beneficial.
  • Addressing barriers and optimizing workflow are crucial for successful implementation.
  • Panel-based PGx testing can enhance utilization for supportive care without increasing workflow burden.
Keywords:
DPYDUGT1A1fluoropyrimidinesimplementationirinotecanoncologypharmacogenetics

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