Bugada Dario, Lorini Luca F, Fumagalli Roberto, Allegri Massimo
Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy.
Italian Pain Group.
Cancers (Basel). 2020 Jul 18;12(7):1951. doi: 10.3390/cancers12071951.
Opioids are extensively used in patients with cancer pain; despite their efficacy, several patients can experience ineffective analgesia and/or side effects. Pharmacogenetics is a new approach to drug prescription based on the "personalized-medicine" concept, i.e., the ability of tailoring treatments to each individual's genetic/genomic profile. Pharmacogenetics aims to identify specific genetic variants that influence pharmacokinetics and pharmacodynamics of drugs, better determining their effectiveness/safety profile. Opioid response is a complex scenario, but some gene variants have shown a correlation with pain sensitivity, as well as with opioid metabolism and clinical efficacy/adverse events. Although questions remain unanswered, some of these gene variants may already be used to identify specific patients' phenotypes that are more prone to experience better clinical response (i.e., better analgesia and/or less adverse events). Once adopted, this approach to opioid prescription may improve a patient's outcome. This review summarizes the available data on genetic variants and opioid response: we will focus on basic pharmacogenetic and its impact in the clinical scenario discussing how they may lead to more appropriate opioid prescription in cancer patients.
阿片类药物广泛应用于癌症疼痛患者；尽管其疗效显著，但仍有部分患者会出现镇痛效果不佳和/或副作用。药物遗传学是一种基于“个性化医疗”概念的药物处方新方法，即根据个体的遗传/基因组特征量身定制治疗方案的能力。药物遗传学旨在识别影响药物药代动力学和药效学的特定基因变异，从而更好地确定其有效性/安全性。阿片类药物反应情况复杂，但一些基因变异已显示出与疼痛敏感性、阿片类药物代谢以及临床疗效/不良事件相关。尽管仍有一些问题尚未得到解答，但其中一些基因变异可能已可用于识别更易出现更好临床反应（即更好的镇痛效果和/或更少的不良事件）的特定患者表型。一旦采用这种阿片类药物处方方法，可能会改善患者的治疗结果。本综述总结了有关基因变异与阿片类药物反应的现有数据：我们将重点关注基础药物遗传学及其在临床情况中的影响，讨论它们如何能在癌症患者中促成更合适的阿片类药物处方。
