Nausea and vomiting are often associated with opioid analgesia in cancer patients; however, only a subset of patients develop such side effects. Here, we tested the hypothesis that the occurrence of nausea and vomiting is modulated by the genetic background of the patients. Whole exome sequencing of DNA pools from patients with either low (n = 937) or high (n = 557) nausea and vomiting intensity, recruited in the European Pharmacogenetic Opioid Study, revealed a preliminary association of 53 polymorphisms. PCR-based genotyping of 45 of these polymorphisms in the individual patients of the same series confirmed the association for six SNPs in AIM1L, CLCC1, MUC16, PDE3A, POM121L2, and ZNF165 genes. Genotyping of the same 45 polymorphisms in 264 patients of the Italian CERP study, also treated with opioids for cancer pain, instead confirmed the association for two SNPs in ZNF568 and PDE3A genes. Only one SNP, rs12305038 in PDE3A, was confirmed in both series, although with opposite effects of the minor allele on the investigated phenotype. Overall, our findings suggest that genetic factors are indeed associated with nausea and vomiting in opioid-treated cancer patients, but the role of individual polymorphisms may be weak. Opioid treatment is a standard and consolidated therapy for relieving pain in advanced cancer patients 1. However, a variable percentage of patients experience poor treatment benefit and also develop side effects 2,3. Nausea and vomiting occur frequently in opioid therapy for cancer-related pain. A recent systematic review of 25 prospective studies 4 found that approximately 50% of patients who took morphine, oxycodone, fentanyl, methadone, or hydromorphone for cancer-related pain experienced nausea (ranging from 3% to 85%), whereas the occurrence of vomiting in the same patients ranged from 4% to 50% in the various studies. The wide range in occurrence of nausea and vomiting suggests that genetic factors are involved in individual susceptibility to these side effects. So far, only a few studies have reported genetic polymorphisms associated with the variability in nausea and vomiting among cancer patients receiving opioids. One multicenter European study that examined polymorphisms in genes related to opioid and nausea/vomiting signaling pathways, in 1579 patients receiving opioids for cancer pain, found associations between these side effects and polymorphisms in HTR3B, COMT, and CHRM3 genes 5. Another study looked specifically at polymorphisms in CYP2D6, a gene that encodes an opioid-metabolizing enzyme, and found no effect of CYP2D6 genotypes on nausea 6. Both of these studies followed a candidate-gene approach, involving the analysis of known polymorphisms in genes already shown to participate in opioid action or metabolism or in the expression of nausea and vomiting. A candidate-gene approach, which permits the analysis of only a few genes, has major limitations in the study of the genetics of complex