Patients in Wales to Routinely Receive DPYD Test Ahead of Chemotherapy Treatment
Wales has become the first in the UK to routinely provide all cancer patients being treated with certain types of chemotherapy DPYD screening to identify their risk of severe side effects and help prevent this occurring.
An estimated 10% of patients prescribed fluoropyrimidine drugs, which are widely used for the treatment of cancer, can develop severe, sometimes life-threatening side effects. These toxicities can be triggered by genetic variations in DPYD, the gene that encodes for dihydropyrimidine dehydrogenase (DPD) enzyme which helps to metabolise (break down0 the chemotherapy drugs.
Low levels of the DPD enzyme –predicted by the genetic test– can result in a build-up of these chemotherapy drugs, thereby making the side effects more severe and occasionally fatal.
The DPYD test will be offered prior to the start of chemotherapy with results available in as little as 3 working days. With such quick turnaround times, treatments can be adjusted accordingly leading to significantly improved patient outcomes.
Len Richards, Chief Responsible Officer for Genomics Partnership Wales said:
“Personalised medicine offers many prospects and it is exciting to see Wales once again leading the way in pharmacogenomics by routinely offering DPYD testing for chemotherapy patients across Wales. By screening for DPYD variants at the right time and in an actionable timeframe we are able to provide better treatment options and save lives”.
Richard Adams, Professor and Consultant in Bowel Cancer at Velindre and Cardiff University said:
“As doctors and health care professionals we are tasked with improving the well being of our patients and avoiding doing harm. Over the last 20 years I have seen and cared for many patients who have benefitted from this treatment but also looked after those who have suffered the more severe side effects, with more drastic consequences. This test now allows us to assess the risk of these side effects and in selected patients to change the treatment to reduce the likelihood of this occurring. DPYD screening allows us to improve the quality of care of cancer patients across Wales and save lives".
Dyfrig Hughes, Professor of Pharmacoeconomics at Bangor University said:
“There is great potential for pharmacogenetic testing to change the way medicines are prescribed in order to improve health outcomes. It is very apt that Wales should lead the way in providing a national DPYD testing service, as it was a Welshman, David Price Evans, who played a central role in the development of the field of pharmacogenetics”.
Given the recent success of the pilot phase, which commenced earlier this year in collaboration with Velindre, all health boards across Wales will routinely offer the DPYD test. To date, over 400 samples have been collected with uptake set to increase.
Germline testing on blood samples is available for Welsh cancer patients being treated with common fluoropyrimidine based chemotherapies, 5-fluoruracil and/or capecitabine. A PCR test is performed to identify variants in the dihydropyrimidine dehydrogenase (DPYD) gene that increase a patient’s risk of severe or fatal toxicity to fluoropyrimidine based chemotherapies.
For details about this test please see the DPYD information sheet.
To order the test use this referral form.
Professor Dyfrig Hughes graduated in pharmacy at Cardiff University before undertaking a PhD in cardiovascular pharmacology at the University of Liverpool. He is currently Professor of Pharmacoeconomics and leads the Pharmaceutical Economics, Policy and Pricing Research (PEPPER) group at the Centre for Health Economics and Medicines Evaluation which he co-directs at Bangor University. He is also an honorary professor at the Department of Molecular and Clinical Pharmacology, University of Liverpool.
Dyfrig's research focuses primarily on the safe, effective and efficient use of medicines. His research has resulted in over 170 publications, including in the prestigious medical journals New England Journal of Medicine, Lancet and the BMJ. He has led and contributed to research totalling £56.4m in value. Dyfrig’s involvement in pharmacogenetics includes: chairing the pharmacogenomics test evaluation working group for the Genomics Programme in NHS England and NHS Improvement; being pharmacogenetics champion on behalf of the Royal Pharmaceutical Society; co-chair of the Sub-group on Eligibility Criteria and Testing Volume for the NHS England / Genomics England Joint Working Group on Pharmacogenetics; and member of Genomics Partnership Wales (GPW) Research & Innovation Implementation Group and Programme Board.
Dyfrig is a Health and Care Research Wales Senior Research Leader (since 2016), and is an elected fellow of: The Learned Society of Wales (2013), The British Pharmacological Society (2013), and the Faculty of the Royal Pharmaceutical Society (2014). He is an editorial board member of the journals PharmacoEconomics, Clinical Pharmacology & Therapeutics, British Journal of Clinical Pharmacology and the Orphanet Journal of Rare Diseases.