Safety Tests Before — Your First Chemotherapy Dose
Before your first dose, your team will check that your body is ready for treatment. There is also a second group of tests — genetic ones — that can catch a rare but serious risk before it becomes a problem, and most patients in India are never told these exist.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed September 2026
- Two different kinds — The routine workup and the genetic tests serve different purposes. Most people only receive one.
- Genetic tests are not standard here — Pharmacogenomic tests that can prevent a severe reaction are available in India but not routinely offered.
- You can ask — Whether a genetic test applies to your specific drugs is a question your oncologist can answer.
- Routine tests repeat; genetic ones do not — Blood counts and organ function are checked throughout treatment. Your genetic code does not change.
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Before your first chemotherapy dose, your team will order blood tests, organ function tests, and a heart assessment to confirm your body is ready. A separate group of genetic tests can identify inherited variants that affect how you process certain drugs. These pharmacogenomic tests are not part of the routine workup in India, but can be requested.
Which tests are done before chemotherapy starts?
Your team orders two kinds of tests before chemotherapy starts: a routine workup that confirms your body is ready, and pharmacogenomic tests that check how you will process specific drugs. Almost everyone receives the first. Very few patients in India are offered the second.
The routine workup checks your blood counts, kidney and liver function, and your heart — because chemotherapy affects all of these, and your team needs a baseline before treatment begins.
Pharmacogenomic tests are different. They look at inherited variants in the enzymes your body uses to break down specific chemotherapy drugs. If you carry a variant that slows this process, a standard dose can reach dangerous levels. Your oncologist can tell you whether any drug in your planned regimen has a relevant genetic test.
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What does the routine pre-chemotherapy workup usually include?
- Complete blood countChecks your white cells, red cells, and platelets before any chemotherapy starts.
- Liver function testsOrdered before drugs that are processed through the liver — this covers most regimens.
- Kidney function testsCreatinine and urea levels, essential before platinum-based drugs and several others.
- Blood sugarA baseline reading and a screen for diabetes, which affects how your body handles treatment.
- ECG or echocardiogramRequired before drugs in the anthracycline class and some agents that can affect the heart.
- Hepatitis B and C screeningSome chemotherapy drugs can reactivate a hepatitis infection that has been dormant.
- HIV statusAffects how your team manages the risk of serious infection during treatment.
- Pregnancy testWhere applicable. Chemotherapy carries serious risk to a developing pregnancy.
Did you know?
Certain inherited gene variants can cause a standard dose of some chemotherapy drugs to accumulate to dangerous levels in the body. CPIC and ESMO-PGx guidelines recommend testing for these variants before starting specific regimens.
In India, this testing is available at select molecular diagnostic laboratories but is not yet part of routine oncology practice.
Source: CPIC Clinical Pharmacogenomics Guidelines / ESMO Working Group on Pharmacogenomics
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Frequently asked questions
What is a pharmacogenomic test and how is it different from a regular blood test?
A routine blood test measures what is in your blood right now — your counts, your organ function. A pharmacogenomic test looks at your inherited genetic code to predict how your body will process a specific drug. The variants it looks for were present at birth and will not change over time. They are relevant only for certain chemotherapy drugs, which is why not every patient needs one.
Which chemotherapy drugs are pharmacogenomic tests relevant for?
The most established tests are the DPYD test, used before fluoropyrimidine-based regimens; the TPMT and NUDT15 tests, used before thiopurine drugs given mainly for blood cancers; and the UGT1A1 test, used before irinotecan-containing regimens. Whether any of these applies to you depends entirely on which drugs your oncologist is planning. Ask specifically about the drugs in your regimen and whether a genetic test exists for them.
Is pharmacogenomic testing available in India?
These tests are available at select molecular diagnostic laboratories in India, particularly in larger cities. They are not yet part of routine oncology protocols, and most cancer centres do not order them as standard. If you want to know whether testing is available for your specific regimen, ask your oncologist. Availability varies, and your centre or a referral lab may be able to arrange it.
What happens if a gene variant is found — does my treatment change?
That decision belongs to your oncologist, based on your specific variant, your overall health, and what alternatives exist for your cancer type. Finding a variant does not necessarily mean you cannot have the drug. It means your team has information to plan with. Do not adjust anything on the basis of a result without discussing it with your oncologist first.
Why doesn't my oncologist order pharmacogenomic tests routinely?
Awareness of these tests is still growing across oncology practice in India. Some are not covered by insurance. And the CPIC and ESMO-PGx guidelines that recommend pre-treatment genetic testing for certain drugs have not yet been adopted uniformly across Indian cancer centres. The absence of testing reflects where routine practice currently stands — it is not indifference to your safety, and raising it with your team is entirely reasonable.
Should I ask my oncologist about pharmacogenomic testing?
Yes, it is a reasonable question — particularly if your planned regimen includes drugs for which CPIC or ESMO-PGx guidelines recommend pre-treatment testing. Your oncologist can tell you whether a test applies to your specific drugs and whether it is available at your centre. Raising this is not a challenge to your oncologist's judgment. It is participation in your own care.
Which of these pre-treatment tests are optional and which are required?
The routine workup — blood counts, organ function, heart assessment — is standard and always ordered before treatment begins. It is not optional. Pharmacogenomic tests are not currently required as standard in Indian oncology protocols. They are recommended by international guidelines for specific drugs and available at some centres, but whether to order one is a clinical decision your oncologist makes based on your regimen.
Will these tests need to be repeated during chemotherapy?
The routine tests — blood counts and organ function in particular — are repeated regularly throughout treatment, because chemotherapy affects these values and your team adjusts your care accordingly. Pharmacogenomic tests do not need to be repeated. Your inherited genetic variants do not change, so once the result is known it applies for any future treatment involving the same drug class.
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