A normal test: the dose still in his bag
Educational use only. Not clinically reviewed68-year-old man for immediate withholding, evidence-boundary review, escalation to acute oncology, and handoff practice. About 9 simulated minutes.
What you will practise
- Withhold the drug now, without waiting for permission.
- Recognize that a normal pre-treatment panel is not a clearance.
- Record the toxicity with its severity and the day of the cycle.
- Contact the service that owns the treatment, without making that a precondition.
- Record bounded qualified-team supportive intent without selecting treatment.
- Review the boundaries and their certainty.
- Hand off a drug that stays stopped.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Henricks LM, Lunenburg CATC, de Man FM, et al. DPYD genotype-guided dose individualisation of fluoropyrimidine therapy in patients with cancer: a prospective safety analysis. Lancet Oncol. 2018;19(11):1459-1467. Fluoropyrimidine treatment can result in severe toxicity in up to 30% of patients. Of 1103 evaluable patients, 85 (8%) were heterozygous DPYD variant carriers and 1018 (92%) were wild type; severe fluoropyrimidine-related toxicity occurred in 33 (39%) of 85 variant carriers receiving reduced doses and in 231 (23%) of 1018 wild-type patients (p=0.0013).
- Meulendijks D, Henricks LM, Sonke GS, et al. Clinical relevance of DPYD variants c.1679T>G, c.1236G>A/HapB3, and c.1601G>A as predictors of severe fluoropyrimidine-associated toxicity: a systematic review and meta-analysis of individual patient data. Lancet Oncol. 2015;16(16):1639-1650. Across 7365 patients from eight studies, adjusted relative risks for severe fluoropyrimidine-associated toxicity were 4.40 (95% CI 2.08-9.30) for c.1679T>G, 2.85 (1.75-4.62) for DPYD*2A and 3.02 (2.22-4.10) for c.2846A>T; c.1601G>A was not significantly associated (1.52, 0.86-2.70).
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.