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This academic article explores the complexities surrounding dihydropyrimidine dehydrogenase (DPD) deficiency screening in patients receiving 5-fluorouracil (5-FU) based chemotherapy. The authors present a case study of a fatal reaction to capecitabine, a prodrug of 5-FU, to illustrate the severe, potentially life-threatening toxicity that can occur in DPD-deficient individuals. The text analyzes various methods of DPD testing, highlighting their limitations in meeting the criteria for routine screening, and discusses the ethical considerations of offering such testing. Ultimately, the article advocates for patient counseling on the risks of 5-FU and the option of DPD testing, while emphasizing the need for healthcare providers to monitor for early signs of toxicity and consider alternative therapies or dose reductions when appropriate.
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