title: Morphine or oxycodone for cancer-related pain? A randomized, open-label, controlled trial.
abstract: BACKGROUND
  There is wide interindividual variation in response to morphine for cancer-related pain; 30% of patients do not have a good therapeutic outcome. Alternative opioids such as oxycodone are increasingly being used, and opioid switching has become common clinical practice.
  
  
  OBJECTIVE
  To compare clinical response to oral morphine vs. oral oxycodone when used as first-line or second-line (after switching) treatment in patients with cancer-related pain.
  
  
  METHODS
  In this prospective, open-label, randomized, controlled trial (ISRCTN65155201) with a selected crossover phase, patients with cancer-related pain were randomized to receive either oral morphine or oxycodone as first-line treatment. Dose was individually titrated until the patient reported adequate pain control. Patients who did not respond to the first-line opioid (either because of inadequate analgesia or unacceptable adverse effects) were switched to the alternative opioid.
  
  
  RESULTS
  Two hundred patients were recruited. On intention-to-treat analysis (n = 198, morphine 98, oxycodone 100), there was no significant difference between the numbers of patients responding to morphine (61/98 = 62%) or oxycodone (67/100 = 67%) when used as a first-line opioid. Similarly, there was no significant difference in subsequent response when patients were switched to either morphine (8/12 = 67%) or oxycodone (11/21 = 52%). Per-protocol analysis demonstrated a 95% response rate when both opioids were available. There was no difference in adverse reaction scores between morphine and oxycodone either in first-line responders or nonresponders.
  
  
  CONCLUSIONS
  In this population, there was no difference between analgesic response or adverse reactions to oral morphine and oxycodone when used as a first- or second-line opioid. These data provide evidence to support opioid switching to improve outcomes.
authors: Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom. Electronic address: julia.riley@rmh.nhs.uk.
authors: Julia
authors: J
authors: Riley
authors: Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom; St. Joseph's Hospice, London, United Kingdom.
authors: Ruth
authors: R
authors: Branford
authors: Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors: Joanne
authors: J
authors: Droney
authors: Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors: Sophy
authors: S
authors: Gretton
authors: National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors: Hiroe
authors: H
authors: Sato
authors: Royal Marsden NHS Foundation Trust, London, United Kingdom.
authors: Alison
authors: A
authors: Kennett
authors: Royal Marsden NHS Foundation Trust, London, United Kingdom.
authors: Christina
authors: C
authors: Oyebode
authors: Royal Marsden NHS Foundation Trust, London, United Kingdom.
authors: Michael
authors: M
authors: Thick
authors: National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors: Athol
authors: A
authors: Wells
authors: Royal Marsden NHS Foundation Trust, London, United Kingdom.
authors: John
authors: J
authors: Williams
authors: National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors: Ken
authors: K
authors: Welsh
authors: Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors: Joy
authors: J
authors: Ross
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D018592:Cross-Over Studies; D057915:Drug Substitution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use*; D009369:Neoplasms / Q000503:physiopathology*; D010098:Oxycodone / Q000009:adverse effects / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D010098:Oxycodone
keywords: Morphine; cancer-related pain; opioid switching; oxycodone