Pharmacogenetics in the Treatment and Supportive Care of Patients With Cancer

Presenter: David S. Craig

For patients undergoing treatment for cancer-induced pain, the identification and evaluation of pharmacogenetic variability may improve outcomes. Metabolism of opioids and other analgesic agents is influenced by patient-specific variables and drug–drug interactions, which often pose clinical challenges. Consultation with a clinical pharmacist or pharmacogenetics specialist is recommended to aid in the interpretation and evaluation of pharmacogenetic test results. The current NCCN Guidelines for Adult Cancer Pain provide pharmacogenetic considerations and recommendations for the treatment and supportive care of this population.

Disclosures: Dr. Craig has disclosed receiving consulting fees from Purdue Pharma LP and Trevena.

Correspondence: David S. Craig, PharmD, Moffitt Cancer Center, Department of Pharmacy, 12902 Magnolia Drive, Tampa, FL 33612. Email: david.craig@moffitt.org
  • 1.

    Caudle KE, Gammal RS, Whirl-Carrillo M, et al. Evidence and resources to implement pharmacogenetic knowledge for precision medicine. Am J Health Syst Pharm 2016;73:19771985.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Rakvåg TT, Klepstad P, Baar C, et al. The Val158Met polymorphism of the human catechol-O-methyltransferase (COMT) gene may influence morphine requirements in cancer pain patients. Pain 2005;116:7378.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Drewe J, Ball HA, Beglinger C, et al. Effect of P-glycoprotein modulation on the clinical pharmacokinetics and adverse effects of morphine. Br J Clin Pharmacol 2000;50:237246.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Mogil JS, Ritchie J, Smith SB, et al. Melanocortin-1 receptor gene variants affect pain and μ-opioid analgesia in mice and humans. J Med Genet 2005;42:583587.

  • 5.

    Lötsch J, Geisslinger G. Current evidence for a genetic modulation of the response to analgesics. Pain 2006;121:15.

  • 6.

    U.S. Food and Drug Administration. Table of pharmacogenomic biomarkers in drug labeling. Accessed April 12, 2022. Available at: https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling

    • Search Google Scholar
    • Export Citation
  • 7.

    Swarm RA, Youngwerth JM, Agne JL, et al. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Adult Cancer Pain. Version 1.2022. Accessed April 12, 2022. Available at NCCN.org

    • Search Google Scholar
    • Export Citation
  • 8.

    Lötsch J, Geisslinger G. Are μ-opioid receptor polymorphisms important for clinical opioid therapy? Trends Mol Med 2005; 11:8289.

  • 9.

    Coffman BL, Rios GR, King CD, et al. Human UGT2B7 catalyzes morphine glucuronidation. Drug Metab Dispos 1997;25:14.

  • 10.

    Sanchez-Covarrubias L, Slosky LM, Thompson BJ, et al. P-glycoprotein modulates morphine uptake into the CNS: a role for the non-steroidal anti-inflammatory drug diclofenac. PLoS One 2014;9:e88516.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Moody DE, Liu F, Fang, WB, et al. Azole antifungal inhibition of buprenorphine, methadone and oxycodone in vitro metabolism. J Anal Toxicol 2015;39:374386.

  • 12.

    Charpiat B, Tod M, Darnis B, et al. Respiratory depression related to multiple drug–drug interactions precipitated by a fluconazole loading dose in a patient treated with oxycodone. Eur J Clin Pharmacol 2017;73: 787788.

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 428 428 428
PDF Downloads 193 193 193
EPUB Downloads 0 0 0