PHARMACOKINETIC AND PHARMACOGENETIC ASPECTS OF PERSONALIZED ANALGETIC THERAPY WITH FENTANIL TTS IN CLINICAL ONCOLOGY

• Main Authors: O. P. Bobrova, Y. A. Dyhno, N. A. Shnayder, M. M. Petrova, S. K. Zyryanov
• Format: Article
• Language: Russian
• Published: Tomsk National Research Medical Center of the Russian Academy of Sciences 2018-07-01
• Series: Sibirskij Onkologičeskij Žurnal
• Subjects: fentanyl tts; pharmacokinetics; pharmacogenetics; chronic pain syndrome; oncology; personalization; literature review
• Online Access: https://www.siboncoj.ru/jour/article/view/770

The aim of the study was the pharmacokinetic and pharmacogenetic analysis of analgetic efficacy and safety of transdermal fentanyl for cancer patients.Material and methods. A comprehensive search for journal articlespublished between 2012 and 2017 was carried out using PubMed, Scopus, Web of Science, and E-library databases.Results. The analysis of the data showed that pharmacokinetic and pharmacogenetic factors can influence the interindividual variability  of analgesic therapy with fentanyl TTC for cancer patients,  predetermining phenotypic differences in the efficacy and safety of  analgesia. Enforced polypharmacotherapy with the use of inducers or inhibitors of the CYP3A4 isoenzyme activity can significantly change  the effectiveness of analgesic therapy and result in undesirable side  effects of strong opioids. Contradictory data on the effect of some  single nucleotide polymorphisms of metabolic genes, transport genes and mu-opioid receptor genes dictate the necessity of further studies in this field.Conclusion. To date, there is no single explanation for interindividual variability of analgesic therapy with fentanyl TTS. A  comprehensive assessment of the pharmacokinetic and pharmacogenetic factors affecting the efficacy and safety of  analgesic therapy with potent opioids is a tool of a personalized approach for anesthesia in clinical oncology.