Table 2.

DPWG (2014) Recommendations for Irinotecan and UGT1A1 Genotype.

Phenotype / genotypeRecommendations
UGT1A1 intermediate metabolizer (IM)NO action is needed for this gene-drug interaction.
UGT1A1 poor metabolizer (PM)Start with 70% of the standard dose
If the patient tolerates this initial dose, the dose can be increased, guided by the neutrophil count.
UGT1A1 *1/*28 NO action is needed for this gene-drug interaction.
UGT1A1 *28/*28 Start with 70% of the standard dose
If the patient tolerates this initial dose, the dose can be increased, guided by the neutrophil count.

Please see Therapeutic Recommendations based on Genotype for more information from the DPWG. Table is adapted from (4).

From: Irinotecan Therapy and UGT1A1 Genotype

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