Safe administration of irinotecan, oxaliplatin and raltitrexed in a DPD-deficient patient with metastatic colon cancer

Dihydropyrimidine dehydrogenase deficiency is diagnosed more frequently and is now generally accepted as a potentially life-threatening condition. It predisposes patients receiving treatment with fluoropyrimidines such as 5-f luorouracil (5-FU) to severe and, in case of complete dihydropyrimidine deh ydrogenase deficiency, often fatal toxicity. A patient who had severe side effects following standard dose adjuvant 5-FU exposure was diagnosed of hav ing hereditary partial dihydropyrimidine dehydrogenase deficiency. When the patient relapsed with liver metastases, we treated him with the non-fluoro pyrimidine cytotoxic agents irinotecan, oxaliplatin and raltitrexed in sequ ential manner, and were able to show that these drugs can be safely applied in patients with this metabolic defect.