Capecitabine is an orally available fluoropyrimidine and is finally converted to 5-FU selectively in tumor tissues. In our study, we examined whether the antitumor activity of capecitabine is directly affected by a modulation of dihydropyrimidine dehydrogenase (DPD). The modulations were carried out by the overexpression of DPD in tumor cells and by tumor selective DPD inhibition. The DPD-overexpressing cells were obtained by transfection of human DPD cDNA into HCT116 human colorectal cancer cells. The HCT116 cells bearing DPD cDNA expressed about 13 times higher DPD activities than the parental HCT116 cells, and they became significantly less susceptible to capecitabine than the parental cells when transplanted into nude mice. Administration of RO0094889 that is converted to a DPD inhibitor 5-vinyluracil selectively in tumor tissues restored the antitumor activity of capecitabine against the tumor of the HCT116 cells carrying DPD cDNA and various tumors expressing DPD. As compared to 5-ethynyluracil or 5-vinyluracil, which inhibited DPD not only in tumor tissues but also in other non-cancerous tissues, the effective dose range of RO0094889 in augmenting the efficacy of capecitabine was much broader. These results indicate that the antitumor activity of capecitabine is directly affected by DPD activities in tumor tissues and therefore, the combination of capecitabine and a tumor selective DPD inhibitor, RO0094889, will be beneficial to patients who have tumors with high levels of DPD. © 2003 Wiley-Liss, Inc. Key words: dihydropyrimidine dehydrogenase; thymidine phosphorylase; 5-fluorouracil; 5-vinyluracil; prodrug Dihydropyrimidine dehydrogenase (DPD, EC 1.3.1.2) is the enzyme responsible for the initial step of pyrimidine catabolism. It is expressed in liver and several types of neoplastic tissues and converts pyrimidines to dihydropyrimidines that are further catabolized to ureidopropionic acid and -alanine by dihydropyrimidinase and -ureidopropionase, respectively. 1,2 Because DPD also degrades 5-fluorouracil (5-FU), the efficacy and toxicity of 5-FU are highly affected by DPD activities. 3-8 Administration of DPD inhibitors, 5-ethynyluracil (5-EU) and 5-chloro-2,4-dihydroxypyridine (CDHP), inhibits DPD activities in liver and increases the concentrations of 5-FU in plasma and many other tissues. 9,10 Furthermore, administration of 5-FU exhibited severe toxicity against patients who are defective in DPD activities, 11-16 and such patients have been thought to be heterozygous or homozygous for a mutated DPD gene. [17][18][19] The DPD deficiency is inherited as an autosomal recessive trait 18 and it is estimated that approximately 3% of the world population to be heterozygous for a mutant DPD gene. 18,20 Therefore, the systemic inhibition of DPD would enhance not only the efficacy but also the toxicity of fluoropyrimidine anticancer drugs. On the other hand, the tumor selective inhibition of DPD may augment the efficacy but not the toxicity of 5-FU.Previously, we developed capecitabine (N 4 -pentyloxyca...