Standard-Dose Trifluridine/Tipiracil as Safe Treatment Alternative in Metastatic Colorectal Cancer Patients With DPD Deficiency

Clinical Practice Points • Severe toxicity of the fluoropyrimidine drugs 5-fluorouracil (5-FU) and its oral prodrug capecitabine is associated with deficiency of the primary inactivating enzyme dihydropyrimidine dehydrogenase (DPD). • Pretreatment screening for DPD deficiency is applied followed by initial dose reduction in DPD-deficient patients in order to prevent severe toxicity Nonetheless, severe toxicity may still occur and therefore, new treatment options are highly warranted. • Trifluridine/tipiracil is a new anticancer drug that is registered for the treatment of metastatic colorectal cancer in patients who have been previously treated with, or have contraindications for 5-FU-based chemotherapy. Importantly, its metabolism is completely independent of DPD. • Thereby, trifluridine/tipiracil may offer a new treatment paradigm for the safe treatment of DPD-deficient metastatic colorectal cancer patients.