Cancer & immunosuppressive PGx.
Information for your care team. A gene panel for medications used in cancer treatment and immunosuppression — thiopurines, methotrexate, tamoxifen, anti-nausea drugs and transplant medications such as tacrolimus. One saliva sample, run in our CLIA-certified lab, with results your prescriber can refer back to.
- One sample, no blood draw
- Results in 3–7 business days
- Share with any prescriber
Panel
8 genes
Sample
Saliva or cheek swab
Results
3–7 business days
Price
From $289
What we test
Anti-cancer and immunosuppressive medications.
See how your genes may affect your response to certain medications. Review your results with your prescriber.
Thiopurines — TPMT, NUDT15
Azathioprine, mercaptopurine and thioguanine: poor metabolizers risk severe bone-marrow suppression at standard doses.
Cisplatin — TPMT, NUDT15
Genotype informs tolerability of platinum chemotherapy regimens.
Methotrexate — MTHFR
Folate-pathway variants can influence both efficacy and toxicity.
Tamoxifen, gefitinib — CYP2D6
Tamoxifen must be activated by CYP2D6; poor metabolizers may get less benefit from the standard dose.
Anti-nausea — CYP2D6
Ondansetron, tropisetron, meclizine and metoclopramide, where metabolism changes how well the anti-nausea cover works.
Tacrolimus, cyclosporine, sirolimus — CYP3A4, CYP3A5
CYP3A5 expressers typically need higher tacrolimus doses to reach target levels.
Erdafitinib — CYP2C9
Metabolizer status informs dosing of this targeted cancer therapy.
Who this is for
Genetic differences can change both how well a drug works and the risk of serious toxicity.
Starting cancer treatment
Testing before a thiopurine or chemotherapy cycle puts safety information in hand from day one.
Tamoxifen therapy
CYP2D6 status is directly relevant to how much active drug you produce.
A severe past reaction
Severe side effects from a previous cancer treatment are exactly what this panel is designed to anticipate.
Transplant medications
Tacrolimus, cyclosporine or sirolimus dosing is heavily metabolism-dependent.
Is this test right for you?
You are about to start chemotherapy or a thiopurine.
You take or will take tamoxifen.
You had severe side effects from a previous cancer treatment.
You take tacrolimus, cyclosporine or sirolimus after a transplant.
Anti-nausea medication has not worked well for you.
Your oncologist or transplant team suggested genetic testing.
Answering yes to even one of these is a good reason to test before the next prescription change.
Before you order
Total price
From $289
One-time price, shown in full at checkout before you pay. No separate fee for the kit, return shipping or the healthcare provider order.
What's included
Kit to report
A saliva or cheek-swab kit with instructions, a prepaid return label, the healthcare provider order, genetic testing in our lab and a gene-drug report in your secure portal.
When to expect results
3–7 business days
After the lab receives your sample. You are notified as soon as your report is in your secure portal.
The science
What the evidence says about getting tested.
Cancer and transplant medications have some of the narrowest safety margins in medicine. The same thiopurine dose that keeps one patient in remission can cause profound bone-marrow suppression in another, and tacrolimus levels swing widely between people. The genes on this panel — TPMT, NUDT15, CYP2D6, CYP3A5 and others — explain much of that variability, and clinical guidelines built on them are already in routine oncology and transplant use.
1 in 300
people inherit two TPMT deficiency copies and are at high risk of severe thiopurine bone-marrow suppression at standard doses.
Source: CPIC thiopurine guideline
About 10%
carry one TPMT deficiency copy, so dosing may need to be adjusted downward.
Source: CPIC thiopurine guideline
≈80%
of people of African ancestry are CYP3A5 expressers who typically need substantially higher tacrolimus doses.
Source: CPIC tacrolimus guideline
≈7%
of people are CYP2D6 poor metabolizers, producing less of the active endoxifen form of tamoxifen.
Source: CPIC CYP2D6/tamoxifen guideline
How often should you test?
Test once — your genotype doesn't change. The highest-value moments are before a thiopurine or chemotherapy cycle starts, before tamoxifen therapy, and before transplant immunosuppression is dosed. If you have had a bone marrow, stem-cell or liver transplant, tell your provider, since a transplant can alter which genes your results reflect.
References
- Relling MV, Gardner EE, Sandborn WJ, et al. Clinical Pharmacogenetics Implementation Consortium guidelines for thiopurine methyltransferase genotype and thiopurine dosing: 2013 update. Clinical Pharmacology & Therapeutics. 2013;93(4):324–325.
- Moriyama T, Nishii R, Perez-Andreu V, et al. NUDT15 polymorphisms alter thiopurine metabolism and hematopoietic toxicity. Nature Genetics. 2016;48(4):367–373.
- Birdwell KA, Decker B, Barbarino JM, et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for CYP3A5 genotype and tacrolimus dosing. Clinical Pharmacology & Therapeutics. 2015;98(1):19–24.
- Goetz MP, Sangkuhl K, Guchelaar HJ, et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 and tamoxifen therapy. Clinical Pharmacology & Therapeutics. 2018;103(5):770–777.
Population data
How common is each metabolizer type?
Published population frequencies for the cytochrome P450 enzymes read on this panel. Your report places you in one of these groups for each enzyme.
| Cytochrome | Poor metabolizer | Intermediate metabolizer | Normal metabolizer | Rapid or ultra-rapid metabolizer |
|---|---|---|---|---|
| CYP2D6 | 4–7% | 9–35% | 50–90% | 2–3% |
| CYP2C9 | 3% | 30% | 68% | N/A |
| CYP2C19 | 2–20% | 24–36% | 14–44% | 30% |
Population frequencies compiled from CPIC guidelines and FDA pharmacogenomic biomarker tables; frequencies vary by ancestry.
Questions people actually ask
Give your care team the safety data up front.
One sample, one flat price, a report your oncology or transplant team can refer back to.