CYP2D6 酶代谢了常规用于癌症相关疼痛的阿片类药物，而 CYP2D6 多态性可能对阿片类药物反应性的可变性起到了一定的贡献。我们评估了在癌症患者中实施以 CYP2D6 为导向的阿片类药物处方的可行性，并报告了试点结果数据。两家癌症中心的成年患者被前瞻性地纳入了一个混合实施效果的临床试验，并被随机分配到了以 CYP2D6 基因型为导向的阿片类药物选择组，以及常规护理组。我们评估了实施指标，包括医生的反应、与推荐一致的药物变更，以及基线和长达8周的患者报告的疼痛和症状评分。研究的大部分患者（114名中的87名，76%）同意参与研究。在随机分配的85名患者中，71%在基线时被开具了盐酸鸦片酮处方。CYP2D6 检测结果的中位数（范围）接收时间为10天（3-37天）；24%的患者的基因型结果被医生记录在临床记录中。在接受了基于 CYP2D6 基因型的推荐更改治疗的患者中（n=11），有18%与推荐一致进行了转变。在完成了基线和随访问卷的患者中（n=48），通常护理组（n=26）和基因型导向组（n=22）之间在平均复合疼痛评分变化（-1.01±2.1 vs -0.41±2.5；p=0.19）和最后随访时症状严重性（3.96 ± 2.18 vs 3.47 ± 1.78；p=0.63）方面没有差异。我们的研究显示出在癌症疼痛患者中，药物基因组学测试作为临床试验的一个部分获得了广泛接受。然而，医生对基于基因型的推荐的反应较低，进而影响了疼痛相关结果的评估。解决药物基因组学结果和临床推荐的应用壁垒将对实施成功至关重要。 该文章受版权保护，版权所有。

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 report pilot outcome data.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.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.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.This article is protected by copyright. All rights reserved.