DPD enzyme test before CAPOX. Essential or not?

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I'm a bit confused and concerned. My CAPOX chemo starts on Thursday 8th January. Today (Tuesday 6th) I had pre-chemo bloods, ECG, and chat with specialist cancer nurse who works in the hospital chemo infusion day unit. I asked the nurse what the result of my DPD enzyme test done on 11-Dec-2025 was - because I'm aware that CAPOX patients with low or zero DPD can suffer life threatening conditions.

She couldn't find my DPD results and stated that it didn't really matter as the Oxaliplatin infusion was quite slow so it shouldn't affect me (!).

I tried to explain that I thought it was the Capecitabine part of the chemo (not Oxaliplatin) that would be affected by lack of DPD but she didn't seem concerned.

I phoned the MacMillan colorectal team assigned to me for their take on this (left an answerphone message), but they usually take a couple of days to get back. I'll ask again on chemo day, just wondering if I've got the wrong end of the stick (usually do), or should I be cautious about this?

The same nurse was surprised when I asked if cold gloves / socks were available for the duration of the infusion; she said that these were the last thing I would want, and that they usually ensure doors are closed near patients having Oxaliplatin infusions to ensure they don't suffer from cold drafts. My suggestion that cooling hands and feet is done to help prevent peripheral neuropathy was met with 'where on earth did you hear that'.

Thanks

CerysM 2 months ago

Hi Knobbly1,

Yes the DPD test is important for the Capecitabine part for the reasons you stated. I have the DPD deficiency and had to go on half dose for twice as long. They might pick this up when the prescribe the Capectabine but I'd mention it at every available opportunity to be safe.

I can't comment on the gloves as I only had the Capecitabine part, but I'm sure others can.

Best wishes

CerysM

Arial88 2 months ago

Hi, that is odd, knowing your DPD status is important. I have heard of icing during the oxaliplatin infusion to prevent neuropathy. Some hospitals go along with it, others aren't so used to it. I think there may have been a thread on it at some point. I didn't try it myself. Good luck with the treatment and hope you get answers re your DPD.

Knobbly1 2 months ago

Many thanks for the replies.

I'm not completely impressed with Macmillan Nurse response. They phoned back and said that they had checked my DPD Enzyme test and that all was OK, no sign of any issue. When I arrived at the Chemo Infusion Day Centre the nurse assigned to me looked through my notes and could see that I have a rare genetic DPD mutation that would make the full-dose capecitabine unsafe and after discussion with the hospital pharmacy reduced it to 50% dose.

Now suffering the after effects of oxaliplatin; first bite syndrome - how painful is that!, pins and needles in my fingers, painful IV site, cold sensitive lips/mouth/throat. Hoping this stops in the next couple of days

Arial88 2 months ago in reply to Knobbly1

Hi there, well done on the first treatment! Pleased to hear your Capecitabine was reduced, the chemo nurses are incredibly on it. I found the tablets not so bad, but yes, the infusion can be a beast! First bite is awful isn't it? Plus the sore infusion arm. A hot water bottle to rest your arm on is nice. Such an array of odd side effects. Wrap up really warm, I used to wear gloves in the house. Take it easy over the next days. Everyone is different but I was flattened for a few days post oxaliplatin.