The Genetic Test Every Patient Should Have Before 5-FU Chemotherapy | Dr. Gabe Brooks
Patient From Hell
42 views
Two of the most widely used chemotherapy drugs in the world, 5-FU and capecitabine, have been in use for decades. A small share of patients carry variants in a gene called DPYD that slow their ability to break these drugs down, which means a standard dose behaves like an overdose in their body.
A single genetic test can identify those patients before the first treatment. Europe recommended universal screening in 2020. The FDA updated the labels for both drugs in 2025, after years of pressure from families who had lost someone.
In this episode of Patient From Hell, host Samira Daswani speaks with Dr. Gabe Brooks, a medical oncologist at the Dartmouth Cancer Center, about what DPD deficiency is, what severe toxicity actually looks like, how and when to get screened, what the test costs, and the exact question to ask before starting either drug.
Guest: Gabriel Brooks, MD, MPH, is a medical oncologist and Associate Professor of Medicine at the Dartmouth Cancer Center and the Geisel School of Medicine. He co-directs the Cancer Population Sciences Research Program and specializes in gastrointestinal cancers, including colorectal cancer.
Chapters
00:00 Introduction
00:27 What DPYD is and why it matters
02:50 When toxicity turns fatal
04:21 5-FU vs. capecitabine
06:16 Which cancers use these drugs
06:53 What the FDA changed
08:26 Why the U.S. took five years longer than Europe
11:27 Warning signs and time to onset
15:28 How and when to get screened
17:39 Germline DNA vs. tumor genomic testing
20:16 The patient advocacy behind the change
24:44 What to ask your oncologist
26:43 What the test costs
28:18 Closing thoughts
Resources: Advocates for Universal DPD/DPYD Testing — test4dpd.org
🎙️ Patient From Hell is hosted by Samira Daswani, cancer survivor, entrepreneur, and founder of Manta Cares. Through candid conversations with patients, physicians, researchers, and healthcare leaders, the show explores the realities of cancer care while empowering patients with practical, evidence-based information.
🔗 Connect with Patient From Hell
Website: https://www.mantacares.com
Disclaimer
This podcast is intended for educational and informational purposes only and should not be considered medical advice. Always consult a qualified healthcare professional regarding diagnosis, treatment, or medical decisions.
The Genetic Test Every Patient Should Have Before 5-FU Chemotherapy | Dr. Gabe Brooks
Patient From Hell
42 views
Two of the most widely used chemotherapy drugs in the world, 5-FU and capecitabine, have been in use for decades. A small share of patients carry variants in a gene called DPYD that slow their ability to break these drugs down, which means a standard dose behaves like an overdose in their body.
A single genetic test can identify those patients before the first treatment. Europe recommended universal screening in 2020. The FDA updated the labels for both drugs in 2025, after years of pressure from families who had lost someone.
In this episode of Patient From Hell, host Samira Daswani speaks with Dr. Gabe Brooks, a medical oncologist at the Dartmouth Cancer Center, about what DPD deficiency is, what severe toxicity actually looks like, how and when to get screened, what the test costs, and the exact question to ask before starting either drug.
Guest: Gabriel Brooks, MD, MPH, is a medical oncologist and Associate Professor of Medicine at the Dartmouth Cancer Center and the Geisel School of Medicine. He co-directs the Cancer Population Sciences Research Program and specializes in gastrointestinal cancers, including colorectal cancer.
Chapters
00:00 Introduction
00:27 What DPYD is and why it matters
02:50 When toxicity turns fatal
04:21 5-FU vs. capecitabine
06:16 Which cancers use these drugs
06:53 What the FDA changed
08:26 Why the U.S. took five years longer than Europe
11:27 Warning signs and time to onset
15:28 How and when to get screened
17:39 Germline DNA vs. tumor genomic testing
20:16 The patient advocacy behind the change
24:44 What to ask your oncologist
26:43 What the test costs
28:18 Closing thoughts
Resources: Advocates for Universal DPD/DPYD Testing — test4dpd.org
🎙️ Patient From Hell is hosted by Samira Daswani, cancer survivor, entrepreneur, and founder of Manta Cares. Through candid conversations with patients, physicians, researchers, and healthcare leaders, the show explores the realities of cancer care while empowering patients with practical, evidence-based information.
🔗 Connect with Patient From Hell
Website: https://www.mantacares.com
Disclaimer
This podcast is intended for educational and informational purposes only and should not be considered medical advice. Always consult a qualified healthcare professional regarding diagnosis, treatment, or medical decisions.