commit 8e14279d0260d729cafb8e9b045bdfddd300ed0e
parent 42201c0d97e21847bf7481d5d4d3ccb4c95d9953
Author: Beau <cbeauhilton@gmail.com>
Date: Fri, 29 Mar 2024 15:20:06 -0500
update
Diffstat:
1 file changed, 9 insertions(+), 1 deletion(-)
diff --git a/site/posts/s1.md b/site/posts/s1.md
@@ -201,16 +201,19 @@ with perhaps more biological justification than a nebulous
definition of ancestry,
would be to deploy CYP2A6 screening of some sort
to select folks who may most benefit from S1 rather than capecitabine.
+
This could be done in several ways,
all of which have precedence in other types of screening
and at some centers.
Ideally you'd do trials to determine if any of these
actually pan out (see above, on the path to hell).
They're all extrapolations.
+
One option would be to screen all patients with known Asian ancestry,
as is done in some centers for various indications
(e.g. GPD deficiency screening for patients of African descent
prior to starting potentially problematic drugs).
+
Another would be to screen only those who have had
dose-limiting GI intolerance to capecitabine,
to make an argument that perhaps they would tolerate S1 better.
@@ -222,7 +225,10 @@ which would be to try infusional 5-FU or a drug from a different class,
depending on the specifics of the situation.
I think an empiric approach would be appropriate,
as it wouldn't require fancy testing which may or may not actually be predictive,
-and is what we do most of the time with other cognate drugs).
+and is what we do most of the time with other cognate drugs,
+even if they have class-effect toxicities -
+some folks just tolerate Drug A better than Drug B).
+
A third option would be to screen everyone
to try and find folks with compatible CYP2A6
to select for up-front S1.
@@ -245,6 +251,8 @@ It pairs nicely with my obsession with the histories of therapies for cancers.
Love me a critical genealogy,* love me some heteroglossia and unfinalizability.
Butler and Bakhtin ftw.
+---
+
\* I idly wondered if there had been much movement on that term,
which I got at least thirdhand from Judith Butler,
and it looks like there's going to be a cool book
