We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Morphine Versus Oxycodone for Cancer Pain Using a Catechol-O-methyltransferase Genotype Biomarker: A Multicenter, Randomized, Open-Label, Phase III Clinical Trial (RELIEF Study).
- Authors
Matsuoka, Hiromichi; Tsurutani, Junji; Chiba, Yasutaka; Fujita, Yoshihiko; Sakai, Kiyohiro; Yoshida, Takeshi; Nakura, Miki; Sakamoto, Ryo; Makimura, Chihiro; Ohtake, Yoichi; Tanaka, Kaoru; Hayashi, Hidetoshi; Takeda, Masayuki; Okuno, Tatsuya; Takegawa, Naoki; Haratani, Koji; Koyama, Atsuko; Nishio, Kazuto; Nakagawa, Kazuhiko
- Abstract
Background We hypothesized that the high-dose opioid requirement in patients carrying the rs4680-GG variant in the COMT gene encoding catechol-O-methyltransferase would be greater for patients taking morphine than for those taking oxycodone, thus providing a much-needed biomarker to inform opioid selection for cancer pain. Methods A randomized, multicenter, open-label trial was conducted at a Japanese hospital's palliative care service. Patients with cancer pain treated with regular doses of nonsteroidal anti-inflammatory drugs or acetaminophen were enrolled and randomized (1:1) into morphine (group M) and oxycodone (group O) groups. The minimum standard dose of immediate-release (IR) oral opioids was repeatedly administered by palliative care physicians to achieve pain-reduction goals (Pain reduction ≥ 33% from baseline and up to ≤ 3 on a numerical rating scale). The primary endpoint was the proportion of subjects requiring high-dose opioids on day 0 with the GG genotype. Results Of 140 participants who developed cancer-related pain among 378 subjects registered and pre-screened for the genotype, 139 were evaluated in the current study. Among patients carrying a COMT rs4680-GG genotype, 48.3% required high-dose opioids in group M, compared with the 20.0% in group O (95% CI, 3.7%-50.8%; P = .029). Of those with the non-GG genotype, 41.5% treated with morphine and 23.1% with oxycodone required high-dose opioids (95% CI, 3.3%-38.3%; P = 0.098). Conclusion Using the COMT rs4680 genotype alone is not recommended for selecting between morphine and oxycodone for pain relief.
- Subjects
JAPAN; CANCER pain; CONFIDENCE intervals; CATECHOLAMINES; MORPHINE; OXYCODONE; TREATMENT effectiveness; RANDOMIZED controlled trials; TRANSFERASES; GENOTYPES; TUMOR markers; OPIOID analgesics; PALLIATIVE treatment; PAIN management
- Publication
Oncologist, 2023, Vol 28, Issue 3, p278
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1093/oncolo/oyac233