The Genetic Test Every Patient Should Have Before 5-FU Chemotherapy | Dr. Gabe Brooks

<p>Two of the most widely used chemotherapy drugs in the world, 5-FU and capecitabine, have been in use since the 1950s. 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.</p><p><br></p><p>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.</p><p><br></p><p>Guest: </p><p>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.</p><p><br></p><p>Chapters</p><p>00:00 Introduction</p><p>00:27 What DPYD is and why it matters</p><p>02:50 When toxicity turns fatal</p><p>04:21 5-FU vs. capecitabine</p><p>06:16 Which cancers use these drugs</p><p>06:53 What the FDA changed</p><p>08:26 Why the U.S. took five years longer than Europe</p><p>11:27 Warning signs and time to onset</p><p>15:28 How and when to get screened</p><p>17:39 Germline DNA vs. tumor genomic testing</p><p>20:16 The patient advocacy behind the change</p><p>24:44 What to ask your oncologist</p><p>26:43 What the test costs</p><p>28:18 Closing thoughts</p><p><br></p><p>Resources: </p><p>Advocates for Universal DPD/DPYD Testing — test4dpd.org🎙️ </p><p><br></p><p>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.</p><p><br></p><p>🔗 Connect with Patient From Hell</p><p>Website: https://www.mantacares.com</p><p><br></p><p>Disclaimer</p><p>This podcast is intended for educational and informational purposes only and should not be considered medical advice. Always consult a qualified healthcare pro