Pain relief using oxycodone is common in the course of a cancer illness including almost every patient who undergoes surgery and almost 90 per cent of those with advanced illness. About 20 per cent of patients will experience uncontrollable pain and unacceptable side effects to oxycodone, resulting in increased suffering and hospital admissions. The reasons are multifactorial. We have shown in a small discovery study that a normal breakdown product of oxycodone, noroxycodone appears to be a major contributor to these poor outcomes. Noroxycodone formation is regulated by cancer-induced inflammation. Headquartered at the Peter MacCallum Cancer Centre, we will study 50 patients who have inadequate pain relief and/or intolerable side effects to oxycodone that normally would require a switch to a more expensive opioid. Using a single blood sample, we will determine (a) how much noroxycodone is in their blood stream, (b) the extent of inflammation and c) their pain and oxycodone genes. This will allow us to start a large scientifically strong international clinical trial to determine which is the best oxycodone dose each individual patient should receive for their cancer pain at the beginning of their pain relief journey, thus bringing Precision Medicine to this neglected field.
Professor Andrew Somogyi, Dr Daniel Barratt, Dr Sanam Mustafa, University of Adelaide, South Australia; Dr Aaron Wong, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne; Professor Andrew Rowland, Flinders University, South Australia.
The project was awarded A$64,158 funding through the ANZCA research grants program for 2025.