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Dihydropyrimidine dehydrogenase (DPD), encoded by the<jats:italic>DPYD<\/jats:italic>gene, is the critical enzyme implicated in FP metabolism.<jats:italic>DPYD<\/jats:italic>variant genotypes can result in decreased DPD production, leading to the development of severe toxicities resulting in hospitalization, intensive care admission, and even death. Management of toxicity incurs financial burden on both patients and healthcare systems alike. Upfront<jats:italic>DPYD<\/jats:italic>genotyping to identify variant carriers allows an opportunity to identify patients who are at high risk to suffer from serious toxicities and allow prospective dose adjustment of FP treatment. This approach has been shown to reduce patient morbidity, as well as improve the cost\u2010effectiveness of managing FP treatment. Upfront<jats:italic>DPYD<\/jats:italic>genotyping has been recently endorsed by several countries in Europe and the United Kingdom. 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