Table 2:

Testing and Dosing Recommendations by Fluoropyrimidine Route of Administration

	DPYD/DPD Testing		Fluoropyrimidine Dosing
	Systemic Fluoropyrimidine Chemotherapy	Topical 5-Fluorouracil	Systemic Fluoropyrimidine Chemotherapy	Topical 5-Fluorouracil
DPWG	Testing is essential	Testing is essential	Partial deficiency: reduce doses Complete deficiency: avoid treatment	Complete deficiency: avoid treatment
CPIC	Not applicable*	Not applicable*	Partial deficiency: reduce doses Complete deficiency: avoid treatment	No statement as to whether dosing recommendations are applicable
EMA	Testing is recommended	Testing recommendation does not apply	Partial deficiency: reduce doses Complete deficiency: avoid treatment	Dosing recommendations are not applicable
FDA**	Consider testing (capecitabine**)	No testing recommendation	Partial deficiency: usual doses Complete deficiency: avoid treatment	Complete deficiency: avoid treatment

^*: CPIC does not provide testing recommendations

^**: FDA recently updated the capecitabine drug label to “consider testing.” Drug labels for intravenous and topical 5-FU have not been updated and do not recommend testing. Labels for capecitabine, intravenous 5-FU, and topical 5-FU recommend against treatment in patients with complete DPD deficiency but do not recommend dose adjustment in patients with partial deficiency.

Abbreviations: CPIC: Clinical Pharmacogenetics Implementation Consortium. DPD: dihydropyrimidine dehydrogenase. DPWG: Dutch Pharmacogenetics Working Group. EMA: European Medicines Agency. FDA: Food and Drug Administration