{"doi":"10.1002/phar.2875","title":"<scp> <i>CYP2D6</i> </scp> ‐guided opioid therapy for adults with cancer pain: A randomized implementation clinical trial","abstract":"INTRODUCTION: The CYP2D6 enzyme metabolizes opioids commonly prescribed for cancer-related pain, and CYP2D6 polymorphisms may contribute to variability in opioid response. We evaluated the feasibility of implementing CYP2D6-guided opioid prescribing for patients with cancer and reported pilot outcome data. METHODS: Adult patients from two cancer centers were prospectively enrolled into a hybrid implementation-effectiveness clinical trial and randomized to CYP2D6-genotype-guided opioid selection, with clinical recommendations, or usual care. Implementation metrics, including provider response, medication changes consistent with recommendations, and patient-reported pain and symptom scores at baseline and up to 8 weeks, were assessed. RESULTS: Most (87/114, 76%) patients approached for the study agreed to participate. Of 85 patients randomized, 71% were prescribed oxycodone at baseline. The median (range) time to receive CYP2D6 test results was 10 (3-37) days; 24% of patients had physicians acknowledge genotype results in a clinic note. Among patients with CYP2D6-genotype-guided recommendations to change therapy (n = 11), 18% had a change congruent with recommendations. Among patients who completed baseline and follow-up questionnaires (n = 48), there was no difference in change in mean composite pain score (-1.01 ± 2.1 vs. -0.41 ± 2.5; p = 0.19) or symptom severity at last follow-up (3.96 ± 2.18 vs. 3.47 ± 1.78; p = 0.63) between the usual care arm (n = 26) and genotype-guided arm (n = 22), respectively. CONCLUSION: Our study revealed high acceptance of pharmacogenetic testing as part of a clinical trial among patients with cancer pain. However, provider response to genotype-guided recommendations was low, impacting assessment of pain-related outcomes. Addressing barriers to utility of pharmacogenetics results and clinical recommendations will be critical for implementation success.","journal":"Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy","year":2023,"id":367387,"datarank":0.3855855147334206,"base_score":1.791759469228055,"endowment":1.791759469228055,"self_citation_contribution":0.26876392038420827,"citation_network_contribution":0.11682159434921234,"self_endowment_contribution":0.26876392038420827,"citer_contribution":0.11682159434921234,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":5,"citers_with_citation_signal":4,"citers_with_endowment":4,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9447,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT02664350"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":640615,"name":"Emily J. Cicali","orcid":"0000-0002-3595-9321","position":1,"is_corresponding":false},{"id":892454,"name":"Alex Del Cueto","orcid":null,"position":2,"is_corresponding":false},{"id":1124527,"name":"Diane Portman","orcid":"0000-0002-8970-755X","position":3,"is_corresponding":false},{"id":667666,"name":"Kristine A. Donovan","orcid":"0000-0003-1183-8709","position":4,"is_corresponding":false},{"id":388359,"name":"Yan Gong","orcid":"0000-0002-8218-1620","position":5,"is_corresponding":false},{"id":527365,"name":"Taimour Langaee","orcid":"0000-0001-5040-6365","position":6,"is_corresponding":false},{"id":724729,"name":"Priya Gopalan","orcid":"0000-0001-8403-8847","position":7,"is_corresponding":false},{"id":1124957,"name":"Jessica M. Schmit","orcid":null,"position":8,"is_corresponding":false},{"id":246674,"name":"Jason S. Starr","orcid":"0000-0002-8674-8102","position":9,"is_corresponding":false},{"id":516188,"name":"Natalie L. Silver","orcid":"0000-0003-4618-6659","position":10,"is_corresponding":false},{"id":1124528,"name":"Young D. Chang","orcid":"0000-0002-6884-2605","position":11,"is_corresponding":false},{"id":744464,"name":"Sahana Rajasekhara","orcid":"0000-0003-3877-6165","position":12,"is_corresponding":false},{"id":1124958,"name":"Joshua E. Smith","orcid":null,"position":13,"is_corresponding":false},{"id":984543,"name":"Heloisa P. Soares","orcid":"0000-0002-5185-2583","position":14,"is_corresponding":false},{"id":370104,"name":"Michael Clare‐Salzler","orcid":null,"position":15,"is_corresponding":false},{"id":686979,"name":"Petr Starostik","orcid":"0000-0002-8992-1230","position":16,"is_corresponding":false},{"id":263950,"name":"Thomas J. George","orcid":"0000-0002-6249-9180","position":17,"is_corresponding":false},{"id":32979,"name":"Howard L. McLeod","orcid":"0000-0002-9004-9232","position":18,"is_corresponding":false},{"id":301592,"name":"Roger B. Fillingim","orcid":"0000-0002-7699-8183","position":19,"is_corresponding":false},{"id":406577,"name":"J. Kevin Hicks","orcid":"0000-0003-2314-0164","position":20,"is_corresponding":false},{"id":235378,"name":"Larisa H. Cavallari","orcid":"0000-0002-7184-5292","position":21,"is_corresponding":false},{"id":994308,"name":"Scott A. Mosley","orcid":"0000-0003-1460-4000","position":0,"is_corresponding":true}],"reference_count":45,"raw_metadata":null,"created_at":"2026-07-19T01:15:12.215513Z","pmid":"37698371","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}