UGT1A1 Irinotecan toxicity

Alphabetical Test listing

UGT1A1 Irinotecan toxicity-994

Test name:

Test number:

994

Excellian order number:

LAB994

Abbreviation:

MSO

Alternate names:

Camptosar®
Irinotecan

Useful for:

Irinotecan (Camptosar®) is used, or under evaluation, in a broad spectrum of solid tumors, and is often prescribed for treating patients with metastatic cancer of the colon or rectum, especially when 5-fluorouracil treatment has not been entirely successful. Severe toxicity (eg, grade 4 neutropenia) is commonly observed in cancer patients receiving irinotecan who carry the UGT1A1*28 allele, also called TA. This test result will provide valuable information to physicians prior to initiating or modifying treatment or supplementing treatment with additional drugs. UGT1A1 variants have also been reported in patients with disorders of bilirubin metabolism, such as Crigler-Najjar Types I and II, as well as Gilbert syndrome. Between 80% to 100% of Caucasian patients with Gilbert syndrome are reported to have either one or two copies of UGT1A1*28. G71R (*6), a UGT1A1 variant reported in Asian patients with Gilbert syndrome, is not detected by this assay.

Specimen type:

EDTA whole blood

Collection container:

Lavender (EDTA), 10mL

Volume:

5.0 mL

Minimum volume:

3.0 mL

Collection instructions:

Immediately after collection, mix sample thoroughly by gentle inversion, 8 - 10 times, to prevent clotting

Transport container:

Lavender (EDTA), 10mL

Alternate specimen type:

ACD whole blood

Alternate collection container:

Yellow ACD (A or B)

Alternate transport container:

Yellow ACD (A or B)

Transport and stability:

Ambient (preferred) - 7 days

Refrigerated - 1 month

Frozen - 2 years

Reason for rejection:

Hemolysis
Quantity not sufficient for analysis
Improper container/anticoagulant

Performing lab:

LabCorp RTP (511200): R-NX

Days set up:

Weekly/as needed

TAT:

6 - 9 days

Method:

Polymerase chain reaction (PCR) and capillary electrophoresis

Reference ranges:

An interpretive report will be provided

Preauthorization:

This test may require preauthorization from the insurance provider. Check the payer guidelines and, if needed, obtain the pre-authorization prior to sample collection.

CPT codes:

81350

Subject to medical necessity (Y/N):

Yes

LOINC code:

Result 41044-9

Other billing information:

Medical necessity

Hospital clients submitting a request for this assay on an outpatient with Medicare should complete and submit a Molecular Medical billing request form along with the sample.

Complete and submit the form to notify us of the need for Allina Health Laboratory to bill insurance for Molecular testing performed
All information requested is required in order for your request to be completed

Molecular Medicare billing request

Date created:

05/22/2019

Revised date:

06/23/2023

Review date:

04/11/2022