{"entity":{"id":"oncology-pharmacogenomics","kind":"technology","name":"Pharmacogenomic testing before chemotherapy","aka":[],"tldr":"Testing a patient's inherited genes before certain chemotherapies to spot people who cannot break the drug down and would suffer severe, sometimes fatal, side effects.","summary":"Germline variants alter how patients handle several cancer drugs. DPYD variants reduce dihydropyrimidine dehydrogenase and cause severe toxicity with fluorouracil and capecitabine; UGT1A1*28 raises irinotecan toxicity; TPMT and NUDT15 variants make thiopurines dangerous. Pre-treatment DPYD testing is required or recommended across much of Europe and by the NHS, and dose reduction guided by genotype has been shown to cut severe toxicity; matched comparisons of survival in DPYD and UGT1A1 carriers given reduced doses have not found it shortened overall.","status":"established","asOf":"2026-10-20","wikipedia":"https://en.wikipedia.org/wiki/Pharmacogenomics","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Pharmacogenomics"}],"tags":["precision"],"related":["dpyd-genotyping","ugt1a1-genotyping","tpmt-nudt15-genotyping"],"cancers":[],"sections":["diagnostics","chemotherapy","supportive-care"],"technologies":[],"targets":[],"drugs":["fluorouracil","capecitabine","irinotecan"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Genotype defined variants from blood or saliva and adjust starting doses according to consortium guidelines such as those of the Clinical Pharmacogenetics Implementation Consortium.","strengths":["Prevents severe and fatal toxicity","Cheap, once-per-lifetime test","Guideline-backed dose tables"],"limitations":["Covers only known variants and ancestries unevenly","Turnaround can delay treatment","Uptake outside Europe remains patchy"]},"route":"/technologies/oncology-pharmacogenomics/","neighbours":{"technology":[{"id":"dpyd-genotyping","kind":"technology","name":"DPYD genotyping and DPD phenotyping before fluoropyrimidines","route":"/technologies/dpyd-genotyping/"},{"id":"pkpd-modelling","kind":"technology","name":"Pharmacokinetic and pharmacodynamic modelling","route":"/technologies/pkpd-modelling/"},{"id":"quantitative-systems-pharmacology","kind":"technology","name":"Quantitative systems pharmacology (QSP)","route":"/technologies/quantitative-systems-pharmacology/"},{"id":"tpmt-nudt15-genotyping","kind":"technology","name":"TPMT and NUDT15 genotyping before thiopurines","route":"/technologies/tpmt-nudt15-genotyping/"},{"id":"ugt1a1-genotyping","kind":"technology","name":"UGT1A1 genotyping before irinotecan","route":"/technologies/ugt1a1-genotyping/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"drug":[{"id":"capecitabine","kind":"drug","name":"Capecitabine","route":"/drugs/capecitabine/"},{"id":"fluorouracil","kind":"drug","name":"Fluorouracil (5-FU)","route":"/drugs/fluorouracil/"},{"id":"irinotecan","kind":"drug","name":"Irinotecan (and liposomal irinotecan)","route":"/drugs/irinotecan/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"idea":[{"id":"idea-tr1-pre-emptive-pharmacogenomic-testing","kind":"idea","name":"Test DPYD, UGT1A1 and TPMT/NUDT15 before the first dose, everywhere","route":"/ideas/idea-tr1-pre-emptive-pharmacogenomic-testing/"}],"roadmap":[{"id":"precision-roadmap","kind":"roadmap","name":"Precision roadmap: margins measured in millimetres → tests that find a target → doses fitted to the person → precision that changes outcomes","route":"/roadmaps/precision-roadmap/"}],"term":[{"id":"pharmacogenomics-term","kind":"term","name":"Pharmacogenomics","route":"/terms/pharmacogenomics-term/"}]}}