Opportunities for cannabis in supportive care in cancer.

 Related image“Cannabis has the potential to modulate some of the most common and debilitating symptoms of cancer and its treatments, including nausea and vomiting, loss of appetite, and pain.

However, the dearth of scientific evidence for the effectiveness of cannabis in treating these symptoms in patients with cancer poses a challenge to clinicians in discussing this option with their patients. A review was performed using keywords related to cannabis and important symptoms of cancer and its treatments.

Literature was qualitatively reviewed from preclinical models to clinical trials in the fields of cancer, human immunodeficiency virus (HIV), multiple sclerosis, inflammatory bowel disease, post-traumatic stress disorder (PTSD), and others, to prudently inform the use of cannabis in supportive and palliative care in cancer.

There is a reasonable amount of evidence to consider cannabis for nausea and vomiting, loss of appetite, and pain as a supplement to first-line treatments. There is promising evidence to treat chemotherapy-induced peripheral neuropathy, gastrointestinal distress, and sleep disorders, but the literature is thus far too limited to recommend cannabis for these symptoms.

Scant, yet more controversial, evidence exists in regard to cannabis for cancer- and treatment-related cognitive impairment, anxiety, depression, and fatigue. Adverse effects of cannabis are documented but tend to be mild.

Cannabis has multifaceted potential bioactive benefits that appear to outweigh its risks in many situations. Further research is required to elucidate its mechanisms of action and efficacy and to optimize cannabis preparations and doses for specific populations affected by cancer.”

https://www.ncbi.nlm.nih.gov/pubmed/31413731

https://journals.sagepub.com/doi/10.1177/1758835919866362

Emerging role of cannabinoids and synthetic cannabinoid receptor 1/cannabinoid receptor 2 receptor agonists in cancer treatment and chemotherapy-associated cancer management

Journal of Cancer Research and Therapeutics“Cannabis was extensively utilized for its medicinal properties till the 19th century. A steep decline in its medicinal usage was observed later due to its emergence as an illegal recreational drug.

Advances in technology and scientific findings led to the discovery of delta-9-tetrahydrocannabinol (THC), the primary psychoactive compound of cannabis, that further led to the discovery of endogenous cannabinoids system consisting of G-protein-coupled receptors – cannabinoid receptor 1 and cannabinoid receptor 2 along with their ligands, mainly anandamide and 2-arachidonoylglycerol.  Endocannabinoid (EC) is shown to be a modulator not only for physiological functions but also for the immune system, endocrine network, and central nervous system.

Medicinal research and meta-data analysis over the last few decades have shown a significant potential for both THC and cannabidiol (CBD) to exert palliative effects. People suffering from many forms of advanced stages of cancers undergo chemotherapy-induced nausea and vomiting followed by severe and chronic neuropathic pain and weight loss.

THC and CBD exhibit effective analgesic, anxiolytic, and appetite-stimulating effect on patients suffering from cancer. Drugs currently available in the market to treat such chemotherapy-induced cancer-related ailments are Sativex (GW Pharmaceutical), Dronabinol (Unimed Pharmaceuticals), and Nabilone (Valeant Pharmaceuticals).

Apart from exerting palliative effects, THC also shows promising role in the treatment of cancer growth, neurodegenerative diseases (multiple sclerosis and Alzheimer’s disease), and alcohol addiction and hence should be exploited for potential benefits.

The current review discusses the nature and role of CB receptors, specific applications of cannabinoids, and major studies that have assessed the role of cannabinoids in cancer management.

Specific targeting of cannabinoid receptors can be used to manage severe side effects during chemotherapy, palliative care, and overall cancer management. Furthermore, research evidences on cannabinoids have suggested tumor inhibiting and suppressing properties which warrant reconsidering legality of the substance.

Studies on CB1 and CB2 receptors, in case of cancers, have demonstrated the psychoactive constituents of cannabinoids to be potent against tumor growth.

Interestingly, studies have also shown that activation of CB1 and CB2 cannabinoid receptors by their respective synthetic agonists tends to limit human cancer cell growth, suggesting the role of the endocannabinoid system as a novel target for treatment of cancers.

Further explorations are required to exploit cannabinoids for an effective cancer management.”

http://www.cancerjournal.net/preprintarticle.asp?id=263538

“Could Cannabis Kill Cancer Cells? A New Study Looks Promising”  https://www.portlandmercury.com/blogtown/2019/08/15/26977361/could-cannabis-kill-cancer-cells-a-new-study-looks-promising

“Study Reviews How Marijuana Compounds Inhibit Tumor Growth And Kill Cancer Cells” https://www.marijuanamoment.net/study-reviews-how-marijuana-compounds-inhibit-tumor-growth-and-kill-cancer-cells/

New approaches to cancer therapy: combining Fatty Acid Amide Hydrolase (FAAH) inhibition with Peroxisome Proliferator-Activated Receptors (PPARs) activation.

 Go to Volume 0, Issue ja“Over the course of the last decade, Peroxisome Proliferator-Activated Receptors (PPARs) have been identified as part of the cannabinoid signaling system: both phytocannabinoids and endocannabinoids are capable of binding and activating these nuclear receptors. Fatty Acid Amide Hydrolase (FAAH) hydrolyzes the endocannabinoid Anandamide and other N-Acylethanolamines. These substances have been shown to have numerous anti-cancer effects, and indeed the inhibition of FAAH has multiple beneficial effects that are mediated by PPARα subtype and by PPARγ subtype, especially antiproliferation and activation of apoptosis. The substrates of FAAH are also PPAR agonists, which explains the PPAR-mediated effects of FAAH inhibitors. Much like cannabinoid ligands and FAAH inhibitors, PPARγ agonists show antiproliferative effects on cancer cells, suggesting that additive or synergistic effects may be achieved through the positive modulation of both signaling systems. In this perspective, we discuss the development of novel FAAH inhibitors able to directly act as PPAR agonists and their promising utilization as leads for the discovery of highly effective anti-cancer compounds.”

https://www.ncbi.nlm.nih.gov/pubmed/31407888

https://pubs.acs.org/doi/10.1021/acs.jmedchem.9b00885

Urgent need for “EBMM” in pediatric oncology: Evidence based medical marijuana.

Publication Cover“Marijuana has been used by many different civilizations for numerous different purposes, including its use for medical indications. Recently, there has been significant media coverage of the efficacy of medical marijuana in the treatment of seizures in children with Dravet syndrome, and this has led many to search for other possible pediatric indications for cannabinoids, including many different indications in pediatric cancer. However, there is very little evidence on safety or efficacy of cannabinoids in children being treated with cancer. This commentary accompanies a recent paper by a group in Israel who have published their experience of medical marijuana in 50 children and adolescents with cancer, showing excellent satisfaction and better symptom control, and without significant adverse drug reactions. This study from Israel is an excellent first step, but prospective well-designed trials of medical marijuana in pediatric oncology are urgently needed.”

Flavonoid Derivative of Cannabis Demonstrates Therapeutic Potential in Preclinical Models of Metastatic Pancreatic Cancer.

Image result for frontiers oncology“Pancreatic cancer is particularly refractory to modern therapies, with a 5-year survival rate for patients at a dismal 8%.

One of the significant barriers to effective treatment is the immunosuppressive pancreatic tumor microenvironment and development of resistance to treatment. New treatment options to increase both the survival and quality of life of patients are urgently needed.

This study reports on a new non-cannabinoid, non-psychoactive derivative of cannabis, termed FBL-03G, with the potential to treat pancreatic cancer.

In vitro results show major increase in apoptosis and consequential decrease in survival for two pancreatic cancer models- Panc-02 and KPC pancreatic cancer cells treated with varying concentrations of FBL-03G and radiotherapy.

Meanwhile, in vivo results demonstrate therapeutic efficacy in delaying both local and metastatic tumor progression in animal models with pancreatic cancer when using FBL-03G sustainably delivered from smart radiotherapy biomaterials.

Repeated experiments also showed significant (P < 0.0001) increase in survival for animals with pancreatic cancer compared to control cohorts.

The findings demonstrate the potential for this new cannabis derivative in the treatment of both localized and advanced pancreatic cancer, providing impetus for further studies toward clinical translation.”

https://www.ncbi.nlm.nih.gov/pubmed/31396485

“In this study, a flavonoid derivative of cannabis demonstrates significant therapy potential in the treatment of pancreatic cancer, including radio-sensitizing and cancer metastasis treatment potential. The results justify further studies to optimize therapy outcomes toward clinical translation.”

https://www.frontiersin.org/articles/10.3389/fonc.2019.00660/full

“Flavonoids as anticancer agents: structure-activity relationship study.”  https://www.ncbi.nlm.nih.gov/pubmed/12678721

“The antitumor activities of flavonoids.”  https://www.ncbi.nlm.nih.gov/pubmed/16097445

“Anticancer properties of flavonoids: roles in various stages of carcinogenesis.”  https://www.ncbi.nlm.nih.gov/pubmed/21644918

Attitudes and Beliefs About Medical Usefulness and Legalization of Marijuana among Cancer Patients in a Legalized and a Nonlegalized State.

View details for Journal of Palliative Medicine cover image “There is a growing preference for the use of marijuana for medical purposes, despite limited evidence regarding its benefits and potential safety risks. Legalization status may play a role in the attitudes and preferences toward medical marijuana(MM).

Objectives: The attitudes and beliefs of cancer patients in a legalized (Arizona) versus nonlegalized state (Texas) regarding medical and recreational legalization and medical usefulness of marijuana were compared.

 

Results: The majority of individuals support legalization of marijuana for medical use (Arizona 92% [85-97%] vs. Texas 90% [82-95%]; p = 0.81) and belief in its medical usefulness (Arizona 97% [92-99%] vs. Texas 93% [86-97%]; p = 0.33) in both states. Overall, 181 (91%) patients supported legalization for medical purposes whereas 80 (40%) supported it for recreational purposes (p < 0.0001). Patients preferred marijuana over current standard treatments for anxiety (60% [51-68%]; p = 0.003). Patients found to favor legalizing MM were younger (p = 0.027), had worse fatigue (p = 0.015), appetite (p = 0.004), anxiety (p = 0.017), and were Cut Down, Annoyed, Guilty, and Eye Opener-Adapted to Include Drugs (CAGE-AID) positive for alcohol/drugs (p < 0.0001).

Conclusion: Cancer patients from both legalized and nonlegalized states supported legalization of marijuana for medical purposes and believed in its medical use. The support for legalization for medical use was significantly higher than for recreational use in both states.”

https://www.ncbi.nlm.nih.gov/pubmed/31386595

https://www.liebertpub.com/doi/10.1089/jpm.2019.0218

Olivia Newton John says medicinal cannabis is key to her cancer recovery

“Olivia Newton-John says medicinal marijuana is a key part of her treatment for stage four cancer. In an exclusive interview with 60 Minutes reporter Liz Hayes, Newton-John says that not only has cannabis assisted with her pain management, sleep and anxiety – but it’s having affects on her physical health too. “I’m incredibly pro cannabis,” she told Liz Hayes. “If I don’t take the cannabis, I can feel the pain so I know it’s working.”

 “Newton-John is maintaining her health with a combination of conventional and alternative medicines and remedies. But her husband of ten years, John Easterling, says he’s confident medicinal cannabis is contributing significantly to maintaining her health.
Easterling, who spent years cultivating herbs from the Amazon, has long held a strong belief in the medicinal power of plants. In a greenhouse at the Santa Barbara ranch the couple share in California, he grows various strains of cannabis that he uses to help treat his wife. “Cannabis can be used for so many things,” he told Hayes. “I don’t use the word cure…. but I’m confident. We had MRIs showing a lesser number of tumours, and the majority of the other ones are shrinking.”
 “Now a cannabis convert, Newton-John is joining the fight for medicinal cannabis to be legalised. She and Easterling want Australians to have greater access to the plant, like they do in their home state of California – where both medicinal and recreational cannabis is legal.  She’s also hoping to break down the stigma surrounding cannabis use.
“It’s not a drug, it’s a herb and a plant,” she told Hayes. “I think when people use the word drug, it’s a misconception as to what it is and it gets people thinking, ‘oh it’s just another drug’, but it’s not.” Doctors at the Olivia Newton-John Research Institute will conduct a clinical trial to determine the effectiveness of medicinal cannabis later this year.”
 
 “EXCLUSIVE: Olivia Newton-John and Chloe Lattanzi emotional interview | 60 Minutes Australia” https://www.youtube.com/watch?v=rJtPgpedcFo&feature=share

“Olivia Newton-John: ‘Medicinal cannabis enhanced my quality of life’.  For this special 60 Minutes report, Olivia Newton-John tells Liz Hayes that despite her latest diagnosis she was “getting strong again” and that her quality of life had been greatly enhanced by medicinal cannabis, grown for her by her husband John. Olivia and John are strong believers in the power of plants particularly cannabis. “I really believe the cannabis has made a huge difference,” says Olivia. “I’m confident,” John concurs. Olivia, John and Chloe are now cannabis converts, and now want medicinal cannabis legalised as an alternative treatment in Australia.” https://www.9news.com.au/national/olivia-newton-john-60-minutes-medical-cannabis-advocate-after-cancer-treatment-news/da315271-7387-47e0-a14e-c7fbb9a4b18b

“I have to credit again my wonderful husband because he gives me Cannabis oil that he makes for me, grows the plants here. We’re so lucky in California that we can grow our own, and so he’s made me these incredible tinctures that help with my pain and with sleep, and everything.” https://www.today.com/video/watch-olivia-newton-john-s-full-interview-with-natalie-morales-1455610947796

 Olivia Newton-John: “The choices of your treatment is a very personal thing. I can’t tell anyone else what they should do. I’d like to tell you all something that I did that people should know about. I’ve mixed traditional medicine and herbal medicine and homoeopathic medicine and a lot of mind-body spiritual focus. Staying positive and believing I can get well is really important. I’m very fortunate that I have a husband who’s a plant medicine man who helps me with herbs and medicinal cannabis, it’s been a huge part of my journey. I weaned myself off morphine with cannabis and I just want people to know that that is possible and it’s not going to kill you. If we can start teaching people that cannabis can help keep the pain away and not kill you, that’s an important message to get out there. I want to see an end to cancer in my lifetime. I’ve had three bouts with cancer. I am living with it well, and I think I’m going to see an end of it. And that’s my dream, that it will be gone.” https://www.image.ie/life/olivia-newton-john-shares-her-advice-for-women-with-cancer-154470
 “”I want to see an end to cancer in my lifetime. And if it could be through cannabis, or helping people with cannabis, the patients, particularly who are in pain, that’s my goal. I want everyone to have access to this amazing plant”” https://www.facebook.com/watch/?v=269501097009373
 ““I truly believe medicinal cannabis will play a huge part in defeating cancer.”“I absolutely believe all patients should have the right to try. It is a matter of common-sense and it is a compassionate thing to do for people,” she said,” https://starinvesting.com.au/medicinal-cannabis-to-play-huge-role-in-beating-cancer-olivia-newton-john/
Olivia Newton-John reveals she’s using marijuana grown by her husband to fight cancer – and says reports she was on death’s door hurt her deeply. Australian singing sensation Olivia Newton-John says she has been using marijuana grown by her husband to help her through her cancer battle. ‘I really believe the cannabis has made a huge difference,'”
“‘It Has Helped Incredibly’. It’s an amazing plant, a maligned plant, but it’s helping so many people.”” https://www.inquisitr.com/5330159/home-grown-cannabis-is-helping-olivia-newton-john-amid-cancer-battle-it-has-helped-incredibly/
“Olivia Newton-John says she uses cannabis to treat her stage 4 breast cancer… and her husband grows it at home” https://www.dailymail.co.uk/tvshowbiz/article-6782847/Olivia-Newton-John-uses-cannabis-treat-stage-4-breast-cancer.html
““I’m Living With Cancer and It’s Going Away!” Olivia Newton John Declares That Her Body is “Winning” Against Stage 4 Cancer” https://www.survivornet.com/articles/im-living-with-cancer-and-its-going-away-olivia-newton-john-declares-that-her-body-is-winning-against-stage-4-cancer/
“Mainstream media has reported that the cannabis tincture she takes helps with pain, but Amazon John Easterling eagerly expounds on its many healing properties, including the potential to cause cancer cell death. “Cannabis initiates a number of healing responses that can result in apoptosis, cancer cell death—while healing and strengthening the body,” he detailed. His focus is on the plant as chemovar, a more scientific approach to looking at the many compounds, via terpene and cannabinoid extraction from the whole plant to treat the cancer and the entire body, building the immune system so it can aid in fighting the disease.“ https://culturemagazine.com/olivia-newton-john-and-john-easterling/
“Medicinal cannabis is a big part of my recovery. I’m living proof that it works. It’s a healing herb.” https://www.facebook.com/watch/?v=1580591005362546

Cannabidiol Induces Cell Cycle Arrest and Cell Apoptosis in Human Gastric Cancer SGC-7901 Cells.

 biomolecules-logo“The main chemical component of cannabis, cannabidiol (CBD), has been shown to have antitumor properties.

The present study examined the in vitro effects of CBD on human gastric cancer SGC-7901 cells.

We found that CBD significantly inhibited the proliferation and colony formation of SGC-7901 cells.

These results indicated that CBD could induce G0-G1 phase cell cycle arrest and apoptosis by increasing ROS production, leading to the inhibition of SGC-7901 cell proliferation, thereby suggesting that CBD may have therapeutic effects on gastric cancer.”

https://www.ncbi.nlm.nih.gov/pubmed/31349651

“These findings may be utilized in the development of CBD as a potential drug for the treatment of gastric cancer.”

https://www.mdpi.com/2218-273X/9/8/302

Cannabinoid Signaling in Cancer.

“The family of chemical structures that interact with a cannabinoid receptor are broadly termed cannabinoids. Traditionally known for their psychotropic effects and their use as palliative medicine in cancer, cannabinoids are very versatile and are known to interact with several orphan receptors besides cannabinoid receptors (CBR) in the body. Recent studies have shown that several key pathways involved in cell growth, differentiation and, even metabolism and apoptosis crosstalk with cannabinoid signaling. Several of these pathways including AKT, EGFR, and mTOR are known to contribute to tumor development and metastasis, and cannabinoids may reverse their effects, thereby by inducing apoptosis, autophagy and modulating the immune system. In this book chapter, we explore how cannabinoids regulate diverse signaling mechanisms in cancer and immune cells within the tumor microenvironment and whether they impart a therapeutic effect. We also provide some important insight into the role of cannabinoids in cellular and whole body metabolism in the context of tumor inhibition. Finally, we highlight recent and ongoing clinical trials that include cannabinoids as a therapeutic strategy and several combinational approaches towards novel therapeutic opportunities in several invasive cancer conditions.”

https://www.ncbi.nlm.nih.gov/pubmed/31332734

https://link.springer.com/chapter/10.1007%2F978-3-030-21737-2_4

Strong reasons make strong actions: medical cannabis and cancer—a call for collective action

Logo of curroncol“Call it cannabis, not marijuana or weed.

It has been more than 17 years since the Canadian prohibitory regulations on the use of medical cannabis began to ease and more than 17 weeks (more than 6 months by the time of publication) since the Cannabis Act (Bill C-45) became law. Cannabis use for medical purposes has been part of the historical record and medical writings for millennia. However, it is only in the last 30 years that the workings of the human endocannabinoid system have been described and its receptors discovered. Amazing as all of those developments have been, the challenge of reintegrating cannabis into the science of modern medicine—and particularly care for patients with cancer—is a need whose time has come.

Surveys inform us that patients with cancer are using cannabis to manage symptoms related to cancer and cancer treatment. More concerning is that their use is for a medical need occurring outside the confines of modern cancer care, with patients accessing their cannabis from friends and family, and often from casual or unlicensed suppliers. Beliefs in the benefits of cannabis—for its yet unfounded therapeutic potential—are commonly held or supported by poor-quality evidence. Patients and their caregivers are inundated with media stories about a budding industry and its mergers and acquisitions while it grows to meet a need for what is regarded by some as overlooked and undertreated ailments. How should oncologists and the oncology team, trusted as the informed and compassionate advocates for their patients, reconcile the overwhelming public attention being given to this product—growing more, creating new routes of administration, and reaching for new uses—with the work needed to further the science of cannabis as it pertains to cancer care?

The onus is on us, the community of cancer care providers, to act.

Therapeutic and clinical developments in oncology are resulting in improvements in the survival of many patients. Costly immunologic therapies are promising and are being implemented for a variety of cancers. New science about the microbiome, about cancer detection, and about targeted therapies are being researched. And yet, contrasted against those celebrations of scientific ingenuity are the glaring gaps in the work pertaining to cannabis to settle unsubstantiated claims and anecdotal observations of this elixir for the ages. As clinicians and scientists, we must work to generate the needed evidence-based outcomes and to document or dispel the potential interactions and sequelae between cannabis and prescribed cancer treatments. “There are in fact two things, science and opinion, the former begets knowledge, the latter ignorance”.

The frameworks to lead this charge are ours to create. The current legal framework is focused on issues of access and control to regulate production, distribution, and sale. The medical framework for cannabis research is more tenuous, concentrated in silos of expertise as a result of the previous prohibitory environment. The study of cannabis is ripe for development, but even intra-institutional endeavors require help. The machinery of science requires some assembly and repurposing to address the new challenges.

If the current and future oncology landscape is a challenge for those working in cancer care, we must remember that patients deserve our compassion as they attempt to navigate this emotional journey with or without cannabis. More importantly, they need our support and deserve to see us take leadership in cannabis research. Oncologists who have expertise in both the clinical and scientific worlds must inform the necessary work. We must be the architects of its design, building bridges to industry and patients, while engaging our academic institutions.

“Coming together is a beginning, staying together is progress, and working together is success”.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588059/