Medicinal Cannabis for Cancer
Keywords:
cannabis, cancer, pain, nausea, vomiting, chemotherapyAbstract
There has been a misunderstanding about the use of cannabis for the treatment of cancer, cancer-related symptoms and chemotherapy-induced adverse effects. To encourage the rational medical use of cannabis, this article aimed to provide information regarding cannabis and cancer emphasizing on medical pharmacology, evidence-based medicine, limitations in animal studies and clinical trials, side effects and withdrawal syndromes, and recommendations on its uses in end-state cancer patients. It was found that no cannabis compounds were effective in cancer inhibition in human studies. No statistical significances on the benefits for pain and appetite have been found in cancer patients. Dronabinol and nabilone, the two single synthetic compounds of the natural delta-9-THC, were effective in and thus indicated for alleviating nausea and vomiting induced by chemotherapy. Cannabis and cannabinoids showed synergistic effects with chemotherapeutic agents such as paclitaxel and 5-fluorouracil. They could help improve the quality of life for advanced-stage cancer patients. Consequently, they should be delivered correctly with the right dose, strength, and dosage form under the supervision of trained medical practitioners and pharmacists. Frequent side effects of cannabis included bradycardia, hypotension, dizziness, loss of coordination, muscle weakness, and mood swing. In some cases, more depression, paranoid, and hallucination could be found especially in cancer patients in whom depression co-existed.
Downloads
References
ราชบัณฑิตยสถาน. หนังสืออนุกรมวิธานพืช อักษร ก. พิมพ์ครั้งที่ 2. กรุงเทพฯ: ราชบัณฑิตยสถาน; 2547. https://www.royin.go.th/?ebook=อนุกรมวิธานพืช อักษร ก..
กระทรวงสาธารณสุข. พระราชบัญญัติยาเสพติดให้โทษ (ฉบับที่ 7) พ.ศ. 2562. ราชกิจจานุเบกษา เล่มที่ 136 ตอนที่ 19 ก.; 2562:1-16. http://www.ratchakitcha.soc.go.th/DATA/PDF/2562/E/218/T_0001.PDF
กระทรวงสาธารณสุข. ประกาศกระทรวงสาธารณสุข เรื่อง ระบุชื่อยาเสพติดให้โทษในประเภท 5 (ฉบับที่ 2) พ.ศ. 2562. ราชกิจจานุเบกษา เล่ม 136 ตอนพิเศษ 218 ง 30 สิงหาคม พ.ศ. 2562.; 2562:1-3. https://www.ratchakitcha.soc.go.th/DATA/PDF/2562/E/218/T_0001.PDF.
Guzmán M. Cannabis for the Management of Cancer Symptoms: THC Version 2.0? Cannabis Cannabinoid Res. 2018;3(1):117-119. https://doi.org/10.1089/can.2018.0009
Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327-360. https://doi.org/10.2165/00003088-200342040-00003
Engels FK, de Jong FA, Sparreboom A, et al. Medicinal cannabis does not influence the clinical pharmacokinetics of irinotecan and docetaxel. The Oncologist. 2007;12(3):291-300. https://doi.org/10.1634/theoncologist.12-3-291
Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 2015;313(24):2456-2473. https://doi.org/10.1001/jama.2015.6358
Chen JW, Borgelt LM, Blackmer AB. Cannabidiol: A New Hope for Patients With Dravet or Lennox-Gastaut Syndromes. Ann Pharmacother. 2019;53(6):603-611. https://doi.org/10.1177/1060028018822124
Munson AE, Harris LS, Friedman MA, Dewey WL, Carchman RA. Antineoplastic activity of cannabinoids. J Natl Cancer Inst. 1975;55(3):597-602. https://doi.org/10.1093/jnci/55.3.597
Guindon J, Hohmann AG. The endocannabinoid system and cancer: therapeutic implication. Br J Pharmacol. 2011;163(7):1447-1463. https://doi.org/10.1111/j.1476-5381.2011.01327.x
Velasco G, Sánchez C, Guzmán M. Towards the use of cannabinoids as antitumour agents. Nat Rev Cancer. 2012;12(6):436-444. https://doi.org/10.1038/nrc3247
Khan MI, Sobocińska AA, Czarnecka AM, Król M, Botta B, Szczylik C. The Therapeutic Aspects of the Endocannabinoid System (ECS) for Cancer and their Development: From Nature to Laboratory. Curr Pharm Des. 2016;22(12):1756-1766. https://doi.org/10.2174/1381612822666151211094901
Hermanson DJ, Marnett LJ. Cannabinoids, endocannabinoids, and cancer. Cancer Metastasis Rev. 2011;30(3-4):599-612. https://doi.org/10.1007/s10555-011-9318-8
López-Valero I, Torres S, Salazar-Roa M, et al. Optimization of a preclinical therapy of cannabinoids in combination with temozolomide against glioma. Biochem Pharmacol. 2018;157:275-284. https://doi.org/10.1016/j.bcp.2018.08.023
Liu H, Chen X, Sun J, et al. The Efficacy and Toxicity of Paclitaxel Plus S-1 Compared With Paclitaxel Plus 5-Fu for Advanced Gastric Cancer: A PRISMA Systematic Review and Meta-analysis of Randomized Controlled Trials. Medicine (Baltimore). 2014;93(25):e164. https://doi.org/10.1097/MD.0000000000000164
Śledziński P, Zeyland J, Słomski R, Nowak A. The current state and future perspectives of cannabinoids in cancer biology. Cancer Med. 2018;7(3):765-775. https://doi.org/10.1002/cam4.1312
Guzmán M, Duarte MJ, Blázquez C, et al. A pilot clinical study of Delta9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme. Br J Cancer. 2006;95(2):197-203. https://doi.org/10.1038/sj.bjc.6603236
Ware1 MA, Daeninck P, Maida V. A review of nabilone in the treatment of chemotherapy-induced nausea and vomiting. Ther Clin Risk Manag. 2008;4(1):99-107.
Tramer MR. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic. BMJ. 2001;323(7303):16-16. https://doi.org/10.1136/bmj.323.7303.16
Davis MP. Oral nabilone capsules in the treatment of chemotherapy-induced nausea and vomiting and pain. Expert Opin Investig Drugs. 2008;17(1):85-95. https://doi.org/10.1517/13543784.17.1.85
Smith LA, Azariah F, Lavender VT, Stoner NS, Bettiol S. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group, ed. Cochrane Database Syst Rev. November 2015. https://doi.org/10.1002/14651858.CD009464.pub2
Haney M, Rabkin J, Gunderson E, Foltin RW. Dronabinol and marijuana in HIV(+) marijuana smokers: acute effects on caloric intake and mood. Psychopharmacology (Berl). 2005;181(1):170-178. https://doi.org/10.1007/s00213-005-2242-2
Haney M, Gunderson EW, Rabkin J, et al. Dronabinol and marijuana in HIV-positive marijuana smokers. Caloric intake, mood, and sleep. J Acquir Immune Defic Syndr 1999. 2007;45(5):545-554. https://doi.org/10.1097/QAI.0b013e31811ed205
Badowski M, Yanful PK. Dronabinol oral solution in the management of anorexia and weight loss in AIDS and cancer. Ther Clin Risk Manag. 2018;Volume 14:643-651. https://doi.org/10.2147/TCRM.S126849
Cannabis-In-Cachexia-Study-Group, Strasser F, Luftner D, et al. Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(21):3394-3400. https://doi.org/10.1200/JCO.2005.05.1847
Portenoy RK, Ganae-Motan ED, Allende S, et al. Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain Off J Am Pain Soc. 2012;13(5):438-449. https://doi.org/10.1016/j.jpain.2012.01.003
Johnson JR, Lossignol D, Burnell-Nugent M, Fallon MT. An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. J Pain Symptom Manage. 2013;46(2):207-218. https://doi.org/10.1016/j.jpainsymman.2012.07.014
Lichtman AH, Lux EA, McQuade R, et al. Results of a Double-Blind, Randomized, Placebo-Controlled Study of Nabiximols Oromucosal Spray as an Adjunctive Therapy in Advanced Cancer Patients with Chronic Uncontrolled Pain. J Pain Symptom Manage. 2018;55(2):179-188.e1. https://doi.org/10.1016/j.jpainsymman.2017.09.001
Lynch ME, Campbell F. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. Br J Clin Pharmacol. 2011;72(5):735-744. https://doi.org/10.1111/j.1365-2125.2011.03970.x
Lynch ME, Ware MA. Cannabinoids for the Treatment of Chronic Non-Cancer Pain: An Updated Systematic Review of Randomized Controlled Trials. J Neuroimmune Pharmacol Off J Soc NeuroImmune Pharmacol. 2015;10(2):293-301. https://doi.org/10.1007/s11481-015-9600-6
Vara D, Salazar M, Olea-Herrero N, Guzmán M, Velasco G, Díaz-Laviada I. Anti-tumoral action of cannabinoids on hepatocellular carcinoma: role of AMPK-dependent activation of autophagy. Cell Death Differ. 2011;18(7):1099-1111. https://doi.org/10.1038/cdd.2011.32
Aviello G, Romano B, Borrelli F, et al. Chemopreventive effect of the non-psychotropic phytocannabinoid cannabidiol on experimental colon cancer. J Mol Med Berl Ger. 2012;90(8):925-934. https://doi.org/10.1007/s00109-011-0856-x
Preet A, Ganju RK, Groopman JE. Delta9-Tetrahydrocannabinol inhibits epithelial growth factor-induced lung cancer cell migration in vitro as well as its growth and metastasis in vivo. Oncogene. 2008;27(3):339-346. https://doi.org/10.1038/sj.onc.1210641
Zhu LX, Sharma S, Stolina M, et al. Delta-9-tetrahydrocannabinol inhibits antitumor immunity by a CB2 receptor-mediated, cytokine-dependent pathway. J Immunol Baltim Md 1950. 2000;165(1):373-380. https://doi.org/10.4049/jimmunol.165.1.373
Jatoi A, Windschitl HE, Loprinzi CL, et al. Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. J Clin Oncol Off J Am Soc Clin Oncol. 2002;20(2):567-573. https://doi.org/10.1200/JCO.2002.20.2.567
Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse Health Effects of Marijuana Use. N Engl J Med. 2014;370(23):2219-2227. doi:10.1056/NEJMra1402309
Khan SP, Pickens TA, Berlau DJ. Perspectives on cannabis as a substitute for opioid analgesics. Pain Manag. 2019;9(2):191-203. https://doi.org/10.2217/pmt-2018-0051
Bonnet U, Preuss UW. The cannabis withdrawal syndrome: current insights. Subst Abuse Rehabil. 2017;8:9-37. https://doi.org/10.2147/SAR.S109576
กรมการแพทย์ กระทรวงสาธารณสุข. รูปแบบคลินิกให้คำปรึกษาการใช้สารสกัดกัญชาทางการแพทย์. พิมพ์ครั้งที่ 1. กรุงเทพมหานคร: โรงพิมพ์องค์การสงเคราะห์ทหารผ่านศึก; 2562.
สมาคมการศึกษาเรื่องความปวดแห่งประเทศไทย. แนวทางเวชปฏิบัติความปวดจากมะเร็ง (Clinical practice guideline for cancer pain) ฉบับที่ 1. นนทบุรี: สมาคมการศึกษาเรื่องความปวดแห่งประเทศไทย; 2556.
มะเร็งวิทยาสมาคมแห่งประเทศไทย. ข้อคิดเห็นและคำแนะนำการใช้สารสกัดจากกัญชาในผู้ป่วยมะเร็ง โดยมะเร็งวิทยาสมาคมแห่งประเทศไทย. มะเร็งวิทยาสมาคมแห่งประเทศไทย. https://www.thethaicancer.com/Webpage/Treatment.html.
Downloads
Published
How to Cite
Issue
Section
License
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของราชวิทยาลัยจุฬาภรณ์
ข้อความที่ปรากฏในบทความแต่ละเรื่องในวารสารวิชาการเล่มนี้เป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับราชวิทยาลัยจุฬาภรณ์ และคณาจารย์ท่านอื่น ในราชวิทยาลัยฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใด ๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเองแต่ผู้เดียว
