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

Review of DPYD (fluoropyrimidines) and UGT1A1 (irinotecan) implementation strategies, 2025 FDA and NCCN updated recommendations, logistical barriers, clinical outcomes of implemented programs

This review synthesizes the clinical implementation data for DPYD and UGT1A1 tests guiding fluoropyrimidine and irinotecan chemotherapy respectively, two pillars of gastrointestinal oncology. It integrates 2025 FDA and NCCN regulatory updates, and documents logistical barriers (turnaround times, VUS interpretation, insurance coverage) and clinical outcomes from published DPYD/UGT1A1 implementation programs. Practical recommendations are formulated for centers wishing to deploy these tests routinely.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

UGT1A1 is often overshadowed by DPYD in implementation discussions, yet it guides irinotecan dosing (CPIC A) with comparable clinical impact. This review highlights the importance of joint DPYD+UGT1A1 implementation in preemptive PGx systems, with a focus on colorectal cancers where both drugs are frequently combined (FOLFIRI/FOLFOX).

Clinical impact: 3/3 · Evidence strength: 2/3 · Novelty: 1/2 · Sample size: 0/1 · Publication status: 1/1 → Total: 7/10