Journal Article Epublish
PubMed: 42676478 DOI: 10.3389/fpain.2026.1834786
Impact of genetic polymorphisms on the response to transdermal fentanyl in cancer patients-a single-center, prospective, biological study.
Front Pain Res (Lausanne) 7:1834786
Authors: Lucia Angelini, Irene Azzali, Andrea Carlini, Vincenza Andrisano, Serena Montanari, Monia Dall'agata, Giorgia Simonetti, Maria Teresa Bochicchio, Matteo Paganelli, Vanessa Valenti, Paola Cravero, Margherita Currà, Linda Petrini, Costanza Maria Donati, Alessio G Morganti, Andrea Ardizzoni, Oscar Edoardo Corli, Marco Cesare Maltoni, Romina Rossi, Marianna Ricci
Affiliations
- Palliative Care Unit, IRCCS "Istituto Romagnolo Per Lo Studio Dei Tumori (IRST), Dino Amadori", Meldola, FC, Italy.
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio DeiTumori (IRST) "Dino Amadori", Meldola, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy.
- Department for Life Quality Studies, University of Bologna, Rimini, Italy.
- Biosciences Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico IstitutoRomagnolo per lo Studio dei Tumori "Dino Amadori,", Meldola, Italy.
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Istituto di Ricerche Farmacologiche Mario Negri-IRCCS, Milano, Italy.
Abstract
BACKGROUND/OBJECTIVES
Transdermal fentanyl (TDF) is widely used for moderate-to-severe cancer pain, yet substantial variability in fentanyl exposure, analgesic response, and tolerability remains incompletely explained by clinical factors. We evaluated whether pharmacogenetic variability is associated with pharmacokinetic parameters and clinical outcomes in cancer patients receiving TDF.
METHODS
In this prospective, single-center study, adults with solid or hematological malignancies and chronic cancer pain treated with stable-dose 72 h TDF were enrolled. Blood samples were collected for pharmacokinetic and pharmacogenetic analyses. Serum fentanyl concentrations were quantified using validated gas chromatography-mass spectrometry, and AUC, C max, and t max were calculated using non-compartmental analysis. Genotyping was performed using a predefined pharmacogenetic panel. Analgesic response was defined as a ≥2-point reduction in Numeric Rating Scale score or score = 0 at 72 h. Statistical analyses included correction for multiple testing.
RESULTS
49 patients were included (median age 65 years; 98% stage IV disease); 38 (77.5%) were responders. No significant differences in AUC, C max, or t max were observed between responders and non-responders. TPMT and UGT2B7 variants showed unadjusted associations with clinical response and pharmacokinetic parameters, respectively; however, none remained statistically significant after correction for multiple testing. No significant associations were observed for CYP3A4/5 or ABCB1 variants, nor between genetic variants and adverse events. Pain reduction correlated with improved functional outcomes.
CONCLUSIONS
In this exploratory cohort, pharmacogenetic variability was not robustly associated with TDF pharmacokinetics, analgesic response, or tolerability after correction for multiple testing. These findings do not support the current clinical implementation of pharmacogenetic-guided TDF therapy, but provide hypothesis-generating signals for future studies.
MeSH
Research Design, Pharmacogenetics, Pain, Neoplasms, Analgesics, Polymorphism, Genetic, Fentanyl, Pharmacokinetics, Cancer Pain