Which baseline assessment is commonly performed before starting chemotherapy in a pediatric patient?

• A. Baseline CBC, renal and hepatic function, weight/height, vital signs, and allergy history.
• B. Baseline CBC alone.
• C. Genetic sequencing panel.
• D. Allergy history only.

Answer: (C)

Understanding how a child will metabolize chemotherapy from the start is essential for safe dosing. A baseline genetic sequencing panel can reveal variants in enzymes that process chemotherapy drugs, such as TPMT and NUDT15 for thiopurines and DPYD for fluoropyrimidines. Identifying these genetic differences before treatment begins allows clinicians to tailor initial doses or even choose alternatives to minimize predictable toxicities like severe myelosuppression or hepatotoxicity. Routine baseline labs and vital signs are important for overall health assessment and monitoring during therapy, but they don’t provide the individualized dosing information that genetic data offer. An allergy history alone also falls short of guiding drug metabolism and toxicity risk. So, a genetic sequencing panel stands out as a pre-treatment tool to personalize chemotherapy and enhance safety for pediatric patients.