对FDA关于在用胺进行化疗之前对DPYD进行检测的决定的回应
Daniel L Hertz1, D Max Smith2,3, Stuart A Scott4,5
1Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.
Clinical pharmacology and therapeutics
|June 23, 2023
概括
治疗前对DPYD变异的基因测试对于安全的甲胺 (FP) 化疗至关重要. 证据强烈支持DPYD测试,以预防癌症患者的严重毒性.
科学领域:
- 药物遗传学 药物遗传学
- 在瘤学瘤学.
- 临床药理学 临床药理学
背景情况:
- 甲胺 (FP) 化疗可以导致严重的,危及生命的毒性.
- DPYD基因变异增加了患者患FP相关毒性的风险.
- 治疗前DPYD测试在欧洲是标准的,但在美国不广泛推.
研究的目的:
- 批判性地评估DPYD变体和FP毒性之间的药物遗传关联.
- 评估FDA对推DPYD测试和剂量调整的请愿书的回应.
- 倡导FDA推的DPYD测试和基因型引导的FP剂量.
主要方法:
- 使用FDA的药物遗传金字塔对DPYD-FP药物遗传关联的审查.
- 对FDA更新的capecitabine标签的分析,以回应公民请愿.
- 讨论FDA对遗传测试和剂量调整建议的担忧.
主要成果:
- 证据强烈支持在FP治疗前推DPYD测试.
- 美国食品和药物管理局更新了capecitabine的标签,但没有强制要求DPYD测试或盒装警告.
- 美国食品和药物管理局没有建议对DPYD变种携带者进行FP剂量调整.
结论:
- 强有力的证据证明FDA建议进行治疗前DPYD测试.
- 以基因型为指导的FP剂量调整对于患者安全至关重要.
- 美国应该与欧洲在FP化疗中对DPYD测试的做法保持一致.
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