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Suctioning Death Rattle — SCE Medical Oncology MCQ

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HardSupportive & Palliative OncologySuctioning Death RattleSCE Medical Oncology

Pretreatment DPYD testing before adjuvant capecitabine identifies partial, not complete, DPD deficiency. The benefit of a fluoropyrimidine remains substantial. What is the MHRA-aligned approach?

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Correct answer: A — Consider a reduced starting dose with close toxicity monitoring and cautious later escalation if tolerated

Complete DPD deficiency precludes systemic fluoropyrimidines. With partial deficiency, MHRA advice is to consider a reduced starting dose and monitor closely, with cautious escalation if toxicity does not occur. A normal or partial result never removes the need for first-cycle vigilance; folinic acid would not prevent DPD-mediated toxicity.

Reference: MHRA: DPD testing before systemic fluoropyrimidines. https://www.gov.uk/drug-safety-update/5-fluorouracil-intravenous-capecitabine-tegafur-dpd-testing-recommended-before-initiation-to-identify-patients-at-increased-risk-of-severe-and-fatal-toxicity