Integrating cannabis into clinical cancer care.

D.I Abrams

doi:10.3747/co.23.3099

Abstract

Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are making it possible for patients to obtain the botanical for medicinal use. For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite. Inhaled cannabis is more effective than placebo in ameliorating peripheral neuropathy in a number of conditions, and it could prove useful in chemotherapy-induced neuropathy. A pharmacokinetic interaction study of vaporized cannabis in patients with chronic pain on stable doses of sustained-release opioids demonstrated no clinically significant change in plasma opiates, while suggesting the possibility of synergistic analgesia. Aside from symptom management, an increasing body of in vitro and animal-model studies supports a possible direct anticancer effect of cannabinoids by way of a number of different mechanisms involving apoptosis, angiogenesis, and inhibition of metastasis. Despite an absence of clinical trials, abundant anecdotal reports that describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency orally ingested concentrate, are circulating. Human studies should be conducted to address critical questions related to the foregoing effects.

Highlights

Much attention has been paid to the unearthing of the 2500-year-old mummy known as the “Siberian Ice Maiden.” Discovered in 1993, her subterranean burial chamber included a pouch of cannabis among other archeologic findings[1]
As an oncologist practicing medicine in San Francisco since the early 1980s, I have often said that I need a clinical trial to demonstrate that cannabis is an effective antiemetic about as much as I need a placebo-controlled trial to demonstrate that penicillin is an antibiotic! It would appear that, if the single most active constituent of the plant is licensed and approved for treatment of chemotherapy-induced nausea, that the parent botanical should work
In a follow-up blog poll, the authors reported finding it surprising that 76% of the 1446 physicians responding from around the world were in favour of medicinal cannabis, even though many came from jurisdictions in which it is totally illegal[58]

Summary

Introduction

Much attention has been paid to the unearthing of the 2500-year-old mummy known as the “Siberian Ice Maiden.” Discovered in 1993, her subterranean burial chamber included a pouch of cannabis among other archeologic findings[1]. An earlier systematic review of eighteen randomized controlled trials of cannabinoids in 766 participants with chronic non-cancer pain found that fifteen of the studies reported a significant analgesic effect for the cannabinoids compared with placebo, and a number of the studies noted improvements in sleep[11]. Another review that included six of those eighteen studies in patients with cancer-related pain favoured cannabinoids[12].

Results

Conclusion