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Use of cannabinoids in cancer patients: A Society of Gynecologic Oncology (SGO) clinical practice statement

Published:January 13, 2020DOI:https://doi.org/10.1016/j.ygyno.2019.12.013

      Highlights

      • Tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabinol (CBN) affect the human endocannabinoid system.
      • Cannabinoids reduce chemotherapy induced nausea or vomiting (CINV) and neuropathic pain.
      • Each state has its own regulations for medical and recreational cannabis use.
      • Effects of cannabinoids on chemotherapy, immunotherapy, and tumor growth remain under investigation.
      • Providers should focus indications, alternatives, risks and benefits of medical cannabis use to make appropriate referrals.

      Keywords

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      References

        • National Academies of Sciences, Engineering, and Medicine
        The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.
        National Academies Press, Washington, D.C2017
        • Chaudhry H.J.
        • Hengerer A.S.
        • Snyder G.B.
        Medical board expectations for physicians recommending marijuana.
        JAMA. 2016; 316: 577-578
      1. PDQ Rating System.
        • Sachs J.
        • McGlade E.
        • Yurgelun-Todd D.
        Safety and toxicology of cannabinoids.
        Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics. 2015; 12: 735-746
        • Munro S.
        • Thomas K.L.
        • Abu-Shaar M.
        Molecular characterization of a peripheral receptor for cannabinoids.
        Nature. 1993; 365: 61-65
        • Hill K.P.
        Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review.
        Jama. 2015; 313: 2474-2483
        • Reggio P.H.
        Endocannabinoid binding to the cannabinoid receptors: what is known and what remains unknown.
        Curr. Med. Chem. 2010; 17: 1468-1486
        • Brenneisen R.
        Marijuana and the Cannabinoids: Chapter 2 - Chemistry and Analysis of Phytocannabinoids and Other Cannabis Constituents.
        2007
        • Russo E.B.
        • Marcu J.
        Cannabis pharmacology: the usual suspects and a few promising leads.
        Adv. Pharmacol. 2017; 80 (San Diego, Calif): 67-134
        • Borgelt L.M.
        • Franson K.L.
        • Nussbaum A.M.
        • Wang G.S.
        The pharmacologic and clinical effects of medical cannabis.
        Pharmacotherapy. 2013; 33: 195-209
        • Hilderbrand R.L.
        Hemp & cannabidiol: what is a medicine?.
        Mo. Med. 2018 Jul-Aug; 115: 306-309
        • Aggarwal S.K.
        • Kyashna-Tocha M.
        • Carter G.T.
        Dosing medical marijuana: rational guidelines on trial in Washington state.
        MedGenMed: Medscape General Medicine. 2007; 9: 52
        • Pergam S.A.
        • Woodfield M.C.
        • Lee C.M.
        • Cheng G.S.
        • Baker K.K.
        • Marquis S.R.
        • Fann J.R.
        Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use.
        Cancer. 2017; 123 (Nov 15. (Epub 2017 Sep 25)): 4488-4497https://doi.org/10.1002/cncr.30879
      2. Integrating cannabis into clinical cancer care.
        Curr. Oncol. 2016 Mar; 23 (Epub 2016 Mar 16): S8-S14https://doi.org/10.3747/co.23.3099
        • Parker L.A.
        • et al.
        Regulation of nausea and vomiting by cannabinoids.
        Br. J. Pharmacol. 2011; 163: 1411-1422
      3. Garcia, JM, et al. doi:https://doi.org/10.1016/j.amjmed.2017.12.041.

        • Whiting
        • et al.
        Cannabinoids for medical use: a systematic review and meta-analysis.
        JAMA. 2015; 313 (Jun 23–30): 2456-2473https://doi.org/10.1001/jama.2015.6358
        • Smith L.A.
        • Azariah F.
        • Lavender V.T.
        • Stoner N.S.
        • Bettiol S.
        Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy.
        Cochrane Database Syst. Rev. 2015 Nov 12; 11 (pub2. Review., PMID: 26561338): CD009464https://doi.org/10.1002/14651858.CD009464
        • Mersiades A.J.
        • et al.
        BMJ Open. 2018; 8e020745
        • Schroder S.
        • Beckmann K.
        • Franconi G.
        • et al.
        Can medical herbs stimulate regeneration or neuroprotection and treat neuropathic pain in chemotherapy-induced peripheral neuropathy?.
        Evid. Based Complement. Alternat. Med. 2013; 2013423713
        • Dworkin R.H.
        • O’Connor A.B.
        • Audette J.
        • et al.
        Recommendations for the pharmacological management of neuropathic pain: an overview and literature update.
        Mayo Clin. Proc. 2010; 85: S3-14
        • Rahn E.J.
        • Hohmann A.G.
        Cannabinoids as pharmacotherapies for neuropathic pain: from the bench to the bedside.
        Neurotherapeutics. 2009; 6: 713-737
        • Casey S.L.
        • Vaughan C.W.
        Plant-based cannabinoids for the treatment of chronic neuropathic pain.
        Medicines (Basel). 2018; 5
        • Harris H.M.
        • Sufka K.J.
        • Gul W.
        • ElSohly M.A.
        Effects of delta-9-tetrahydrocannabinol and cannabidiol on cisplatin-induced neuropathy in mice.
        Planta Med. 2016; 82: 1169-1172
        • King K.M.
        • Myers A.M.
        • Soroka-Monzo A.J.
        • et al.
        Single and combined effects of Delta(9) -tetrahydrocannabinol and cannabidiol in a mouse model of chemotherapy-induced neuropathic pain.
        Br. J. Pharmacol. 2017; 174: 2832-2841
        • Ward S.J.
        • McAllister S.D.
        • Kawamura R.
        • Murase R.
        • Neelakantan H.
        • Walker E.A.
        Cannabidiol inhibits paclitaxel-induced neuropathic pain through 5-HT(1A) receptors without diminishing nervous system function or chemotherapy efficacy.
        Br. J. Pharmacol. 2014; 171: 636-645
        • Abrams D.I.
        • Jay C.A.
        • Shade S.B.
        • et al.
        Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial.
        Neurology. 2007; 68: 515-521
        • Wilsey B.
        • Marcotte T.
        • Deutsch R.
        • Gouaux B.
        • Sakai S.
        • Donaghe H.
        Low-dose vaporized cannabis significantly improves neuropathic pain.
        J. Pain. 2013; 14: 136-148
        • Ellis R.J.
        • Toperoff W.
        • Vaida F.
        • et al.
        Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial.
        Neuropsychopharmacology. 2009; 34: 672-680
        • Mouhamed Y.
        • Vishnyakov A.
        • Qorri B.
        • et al.
        Therapeutic potential of medicinal marijuana: an educational primer for health care professionals.
        Drug Healthc Patient Saf. 2018; 10 (Pergam SA, see listed ref): 45-66
        • Taffe M.A.
        • Creehan K.M.
        • Vandewater S.A.
        Cannabidiol fails to reverse hypothermia or locomotor suppression induced by Delta(9) -tetrahydrocannabinol in Sprague-Dawley rats.
        Br. J. Pharmacol. 2015; 172: 1783-1791
        • Nurmikko T.J.
        • Serpell M.G.
        • Hoggart B.
        • Toomey P.J.
        • Morlion B.J.
        • Haines D.
        Sativex successfully treats neuropathic pain characterised by allodynia: a randomised, double-blind, placebo-controlled clinical trial.
        Pain. 2007; 133: 210-220
        • Berman J.S.
        • Symonds C.
        • Birch R.
        Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial.
        Pain. 2004; 112: 299-306
        • Hoggart B.
        • Ratcliffe S.
        • Ehler E.
        • et al.
        A multicentre, open-label, follow-on study to assess the long-term maintenance of effect, tolerance and safety of THC/CBD oromucosal spray in the management of neuropathic pain.
        J. Neurol. 2015; 262: 27-40
        • Serpell M.
        • Ratcliffe S.
        • Hovorka J.
        • et al.
        A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment.
        Eur. J. Pain. 2014; 18: 999-1012
        • Langford R.M.
        • Mares J.
        • Novotna A.
        • et al.
        A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis.
        J. Neurol. 2013; 260: 984-997
        • Selvarajah D.
        • Gandhi R.
        • Emery C.J.
        • Tesfaye S.
        Randomized placebo-controlled double-blind clinical trial of cannabis-based medicinal product (Sativex) in painful diabetic neuropathy: depression is a major confounding factor.
        Diabetes Care. 2010; 33: 128-130
        • Hauser W.
        • Petzke F.
        • Fitzcharles M.A.
        Efficacy, tolerability and safety of cannabis-based medicines for chronic pain management - an overview of systematic reviews.
        Eur. J. Pain. 2018; 22: 455-470
        • Stockings E.
        • Campbell G.
        • Hall W.D.
        • et al.
        Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies.
        Pain. 2018; 159: 1932-1954
      4. Cannainoids in palliative medicine.
        J. Palliat. Med. 2017; 20 (Published Online:1 Jul)https://doi.org/10.1089/jpm.2017.0197
        • Bowles D.W.
        • O’Bryant C.L.
        • Camidge D.R.
        • Jimeno A.
        The intersection between cannabis and cancer in the United States.
        Crit. Rev. Oncol. Hematol. 2012; 83: 1-10
        • Reiman A.
        • Welty M.
        • Solomon P.
        Cannabis as a substitute for opioid-based pain medication: patient self-report.
        Cannabis Cannabinoid Res. 2017; 2: 160-166
        • Taha T.
        The effect of cannabis use on tumor response to nivolumab in patients with advanced malignancies.
        in: Oral Presentation at: ESMO 2017 Congress. Madrid, Spain. 2017
        • Cabral G.A.
        • Rogers T.J.
        • Lichtman A.H.
        Turning over a new leaf: cannabinoid and endocannabinoid modulation of immune function.
        J. NeuroImmune Pharmacol. 2015; 10: 193-203
        • Rom S.
        • Persidsky Y.
        Cannabinoid receptor 2: potential role in immunomodulation and neuroinflammation.
        J. NeuroImmune Pharmacol. 2013; 8: 608-620
      5. (a)
        • Hernandez-Cervantes R.
        • Mendez-Diaz M.
        • Prospero-Garcia O.
        • Morales-Montor J.
        Immunoregulatory role of cannabinoids during infectious disease.
        Neuroimmunomodulation. 2017; 24: 183-199
      6. (b)
        • Abrams D.I.
        • Guzman M.
        Cannabis in cancer care.
        Clin. Pharmacol. Ther. 2015; 97: 575-586
      7. (a)
        • Olah A.
        • Szekanecz Z.
        • Biro T.
        Targeting cannabinoid signaling in the immune system: “high”-ly exciting questions, possibilities, and challenges.
        Front. Immunol. 2017; 8: 1487
      8. (b)
        • Abrams D.I.
        Integrating cannabis into clinical cancer care.
        Curr. Oncol. 2016; 23: S8-S14
      9. doi:https://doi.org/10.1016/j.pnpbp.2015.05.010.

        • Chadi N.
        • Levy S.
        What every pediatric gynecologist should know about Cannabis use in adolescents.
        J. Pediatr. Adolesc. Gynecol. 2019 Mar 26; (pii: S1083-3188(19)30167-6)https://doi.org/10.1016/j.jpag.2019.03.004
        • Minerbi A.
        • Häuser W.
        • Fitzcharles M.A.
        Medical Cannabis for older patients.
        Drugs Aging. 2019 Jan; 36: 39-51https://doi.org/10.1007/s40266-018-0616-5
        • Cohen K.
        • Weizman A.
        • Weinstein A.
        Positive and negative effects of cannabis and cannabinoids on health.
        Clin. Pharmacol. Ther. 2019 May; 105 (Epub 2019 Mar 12): 1139-1147https://doi.org/10.1002/cpt.1381
        • Wilkie G.
        • Sakr B.
        • Rizack T.
        Medical marijuana use in oncology: a review.
        JAMA Oncol. 2016; (Mar 17. [Epub aheaed of print])https://doi.org/10.1001/jamaoncol.2016.0155
        • A1 A.
        • Madden P.A.
        • Bucholz K.K.
        • Heath A.C.
        • Lynskey M.T.
        Initial reactions to tobacco and cannabis smoking: a twin study.
        Addiction. 2014 Apr; 109 (Epub 2014 Jan 23): 663-671https://doi.org/10.1111/add.12449
        • Noyes Jr., R.
        • Brunk S.F.
        • Avery D.A.
        • Canter A.C.
        The analgesic properties of delta-9-tetrahydrocannabinol and codeine.
        Clin. Pharmacol. Ther. 1975 Jul; 18: 84-89
        • Marconi A.
        • et al.
        Schizophr. Bull. 2016; 42: 1262-1269
        • Sontineni S.P.
        • Chaudhary S.
        • Sontineni V.
        • Lanspa S.J.
        World J. Gastroenterol. 2009; 15: 1264-1266
      10. Society of Cannabis Clinicians, the Medical Cannabis Institute.