
09/08/2025
๐๐จ๐ฎ๐ซ ๐๐๐ง๐๐ญ๐ข๐ ๐๐ฅ๐ฎ๐๐ฉ๐ซ๐ข๐ง๐ญ ๐๐จ๐ฎ๐ฅ๐ ๐๐๐ค๐ ๐๐๐ง๐๐๐ซ ๐๐ซ๐๐๐ญ๐ฆ๐๐ง๐ญ ๐๐๐๐๐ซ
Chemotherapy: one size does not fit all
Chemotherapy saves lives โ but it can also cause severe side effects in certain patients. Often, the reason lies in our DNA: small inherited differences in genes that control how our bodies process drugs.
Pharmacogenetic testing can detect these differences before treatment begins, allowing oncologists to adjust the drug or dosage to reduce life-threatening toxicity and avoid ineffective therapy.
Three well-proven examples where genetics matter
1. ๐
๐ฅ๐ฎ๐จ๐ซ๐จ๐ฉ๐ฒ๐ซ๐ข๐ฆ๐ข๐๐ข๐ง๐๐ฌ (5-๐
๐, ๐๐๐ฉ๐๐๐ข๐ญ๐๐๐ข๐ง๐) โ DPYD gene Variants in the DPYD gene can drastically reduce DPD enzyme activity, leading to severe or fatal toxicity. Around 4โ5% of cancer patients in some European cohorts carry actionable variants. Testing is now recommended before prescribing these drugs.
2. ๐๐ซ๐ข๐ง๐จ๐ญ๐๐๐๐ง โ UGT1A1 gene The UGT1A1*28 variant increases the risk of severe neutropenia. Its frequency varies by ancestry, reaching over 40% in African ancestry populations. Knowing a patientโs status helps tailor dosing safely.
3. ๐๐ก๐ข๐จ๐ฉ๐ฎ๐ซ๐ข๐ง๐๐ฌ (๐ฆ๐๐ซ๐๐๐ฉ๐ญ๐จ๐ฉ๐ฎ๐ซ๐ข๐ง๐, ๐๐ณ๐๐ญ๐ก๐ข๐จ๐ฉ๐ซ๐ข๐ง๐) โ TPMT & NUDT15 genes Low enzyme activity in TPMT or NUDT15 can cause dangerous bone marrow suppression. Roughly 10% of people carry one low-activity allele, and 1 in 300 have very low/absent activity โ directly informing safer starting doses.
๐๐ฌ ๐ญ๐๐ฌ๐ญ๐ข๐ง๐ ๐๐จ๐ฌ๐ญ-๐๐๐๐๐๐ญ๐ข๐ฏ๐?
For DPYD testing, studies show modest added costs per patient but significant gains in quality-adjusted life years (QALYs). Broader pre-emptive pharmacogenomic panel testing has also been shown to be cost-effective in many healthcare models.
Why pre-emptive testing (the โgenetic passportโ) makes sense
Traditionally, testing happens reactively โ only when a drug is prescribed or after a bad reaction. Pre-emptive testing stores your pharmacogenetic profile in your medical record, ready for any future prescription.
With falling costs of whole-genome sequencing (WGS), capturing all relevant pharmacogenetic variants in one go is now feasible. Several national pilots โ even in newborns โ are testing the concept.
๐๐จ๐ญ๐ญ๐จ๐ฆ ๐ฅ๐ข๐ง๐ ๐๐จ๐ซ ๐ฉ๐๐ญ๐ข๐๐ง๐ญ๐ฌ
Certain chemotherapy drugs have genetic tests that can prevent severe harm โ ask about DPYD, UGT1A1, TPMT, and NUDT15 before treatment.
Evidence shows testing is clinically useful and often cost-effective.
Pre-emptive and whole-genome strategies could make safer, personalised prescribing routine in the near future.
Your DNA might not just guide your treatment โ it could save your life.