Epidiolex (CBD) in Patients With Biochemically Recurrent Prostate Cancer The purpose of this phase I/Ib study is to determine the safety profile of Epidiolex (CBD oil) in biochemically recurrent Studies have shown that CBD may have several benefits for cancer patients. This article highlights the most important effects of CBD on cancer symptoms along with the best brands that sell CBD oil in 2020. In our hospital we notice the popular use of cannabis oil in prostate cancer (PCa) patients, they even replace standard treatment with the use of cannabis oil.
Epidiolex (CBD) in Patients With Biochemically Recurrent Prostate Cancer
The purpose of this phase I/Ib study is to determine the safety profile of Epidiolex (CBD oil) in biochemically recurrent prostate cancer patients. The study consists of a dose escalation part and dose expansion part. The dose expansion part of the study will use the maximum tolerated dose (MTD) determined in the dose escalation part to assess the activity, safety and tolerability of the investigational product in patients with biochemically recurrent prostate cancer after localized therapy with either surgery or radiation.
|Condition or disease||Intervention/treatment||Phase|
|Prostate Cancer Recurrent Prostate Cancer Prostate Adenocarcinoma||Drug: Epidiolex Oral Liquid Product||Phase 1|
Cannabinoids (CBD) have been widely used in medicines for centuries to control pain, nausea or vomiting, and to stimulate appetite, especially in cancer patients. Both cannabinoids receptor 1(CB1) and cannabinoids receptor 2 (CB2) were highly expressed in cultured prostate cancer cells compared to normal prostate cell lines. CBD inhibits tumor growth in xenograft model.
Clinicians have been challenged to improve the treatment of biochemically recurrent (BCR) prostate cancer in which prostatic specific antigen (PSA) rises without radiological or clinical progression years after localized treatment (radical prostatectomy or radiation therapy) with or without hormonal treatment. Approximately 50-90% of men with high-risk prostate cancer will experience a BCR. Based on the abovementioned preclinical observations of CBD’s effect on prostate cancer and its safety data in two non-cancer populations, a phase I study of CBD in men with biochemically recurrent prostate cancer will be conducted.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||21 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||A Phase I/Ib Study on the Safety of Epidiolex in Patients With Prostate Cancer With Rising PSA After Localized Therapy With Either Surgery or Radiation|
|Actual Study Start Date :||August 3, 2020|
|Actual Primary Completion Date :||August 20, 2021|
|Actual Study Completion Date :||August 20, 2021|
A Phase I/Ib on the Safety of Epidiolex in Patients with Prostate Cancer with Rising PSA after Localized Therapy with either Surgery or Radiation
patients with rising PSA after failure of localized therapy will receive Epidiolex PO once daily for up to 12 weeks in the absence of disease progression or unacceptable toxicity. Patients receive an Epidiolex taper for 7-10 days after withdrawing from study for any reason or completion of the study period.
Number of participants with dose-limiting toxicities (treatment-related adverse events) as assessed by the CTCAE v5.0 [ Time Frame: up to 90 days ]
Treatment-related adverse events are those that comprise a dose-limiting toxicity within 30 days after initiation of Epidiolex (i.e., acute DLT). Additionally, Treatment-related adverse events will continue to be monitored for a total of 90 days.
Change in serial PSA levels from baseline throughout the treatment period as an indication of biochemical response. [ Time Frame: within 90 days ]
Biochemical response will be determined by the measurement of PSA at baseline and approximately every 4 weeks during treatment.
Biochemical response will be determined by measurement of PSA approximately every 4 weeks during treatment. PSA velocity is the change in PSA levels over time.
Biochemical response will be determined by measurement of testosterone level approximately every 4 weeks during treatment.
The EORTC quality of life questionnaire (QLQ) 30 is a validated 30-item patient-reported questionnaire assessing quality of life among cancer populations. The quality of life questionnaire-C30 is the core QOL instrument, with 30 items that comprise five functioning scales (physical, social, role, cognitive, and emotional functioning), eight symptom scales (fatigue, nausea/vomiting, pain, dyspnea, sleep disturbances, appetite loss, constipation, and diarrhea), financial impact, and overall quality of life. All raw item scores are transformed to scale scores, linearly converted to range from 0 to 100. For the functioning scales and global QOL, higher scores indicate better functioning. For the symptom scales, higher scores indicate higher symptom burden.
The EORTC quality of life questionnaire (QLQ)-PR25 is a validated 25-item patient-reported questionnaire which complements the EORTC QLQ-C30,core QOL questionnaire. The QLQ-PR25 comprises 25 items assessing sequelae specific to prostate cancer and its treatment, and thus, is intended to supplement the EORTC QLQ-C30. The 25 items comprise six prostate-specific scales: Urinary, Bowel, Use of Incontinence Aids, Prostate Cancer Treatment-Related Symptoms, Sexual Active and Sexual Function. Raw item scores are linearly transformed to a 0 to 100 scale (i.e., same unit of measurement used by the core QLQ-C30 questionnaire). For the QLQ-PR25, higher scores on symptom domains (e.g., urinary, bowel, etc.) indicate greater symptom burden. Higher scores on function domains (e.g., Sexual Function) indicate better functioning.
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
|Ages Eligible for Study:||18 Years and older (Adult, Older Adult)|
|Sexes Eligible for Study:||Male|
|Gender Based Eligibility:||Yes|
|Gender Eligibility Description:||prostate cancer only occurs in male|
|Accepts Healthy Volunteers:||No|
- Completion of localized therapy (prostatectomy or radiotherapy) for prostate adenocarcinoma (either histologically or cytologically confirmed)
- Biochemical (PSA) recurrence, defined as: * PSA of >= 0.2 ng/ml that has increased above nadir following radical prostatectomy OR * PSA increase of 2.0 ng/ml above post-therapy nadir after radiotherapy NOTE: PSA measured at two consecutive time points (separated by 4 or more weeks) is required in order to demonstrate the requisite increase in PSA
- Eastern Cooperative Oncology Group (ECOG) performance status = < 2
- Absolute neutrophil count >= 1,500/microliters (at baseline [pre-study])
- Platelets >= 80,000/microliters (at baseline [pre-study])
- Total bilirubin = < institutional upper limit of normal (at baseline [pre-study])
- Aspartate aminotransferase (AST)(serum glutamic-oxaloacetic transaminase/alanine aminotransferase (ALT)(serum glutamate pyruvate transaminase) = < institutional upper limit of normal (at baseline [pre-study])
- Glomerular filtration rate (GFR) >= 30 mL/min/1.73 m^2 using the Cockcroft-Gault formula (at baseline [pre-study])
- Patients with a prior or concurrent malignancy (non-prostate) whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen as determined by the treating physician are eligible
- Given that worsening of an underlying state of mental depression or suicidal ideation has been reported with Epidiolex, patients should be carefully screened for depression at baseline and if there are indications or a history of depression it is strongly recommended that these patients be closely followed together with behavioral health or psychiatric medical support. Patients with an established diagnosis of depression that, in the assessment of the investigator may make the administration of Epidiolex hazardous, should not be enrolled on this protocol
- Concurrent use of over-the-counter CBD oil, Marinol or marijuana is not permitted. Patients with a history of current over-the-counter CBD oil, Marinol or marijuana use for any reason are eligible only if they do the following: * Complete a one-week washout period prior to study initiation * Refrain from non-study related CBD oil, Marinol or marijuana use while on-study
- Ability to understand and the willingness to sign a written informed consent document
- History of hypersensitivity to Epidiolex (cannabidiol) or sesame seeds (one of the inactive ingredients in Epidiolex)
- Any radiological evidence of metastatic disease (determined by standard of care computed tomography [CT] scans of abdomen. pelvis, chest, whole body bone scan or Axium positron emission tomography scan). Questionable lesions on bone scan will be confirmed by standard of care methods such as plain X-rays or Axium positron emission tomography scan, if not previously performed
- Receipt of prior cytotoxic chemotherapy for recurrent prostate cancer
- Use of androgen deprivation therapy (for example, bicalutamide, flutamide, nilutamide, or leuprolide acetate) concurrently or within the previous 3 months.
- Uncontrolled intercurrent illness such as active infections. Other illnesses will be evaluated and eligibility status determined at the discretion of the treating physician and the investigator
- Psychiatric illness/social situations that would limit compliance with study requirements
- Concomitant use of valproate or clobazam
- Concurrent use of over-the-counter CBD oil, Marinol or marijuana
- Epidiolex is a moderate inhibitor of CYP2C19 and a moderate/strong inhibitor of CYP3A4, therefore concurrent use of CYP2C19 substrates is not allowed
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04428203
CBD Oil for Cancer: Can Cannabis Oil Be Used as a Cure & Treatment?
It’s challenging to find a place that wouldn’t stock CBD today, at least in its traditional oil form. CBD oil has taken the United States by storm, driving the attention of doctors, researchers, and media outlets across the world. Universities are starting their research on the possibility of treating a variety of health conditions with CBD, including cancer.
As CBD continues to change the public perception of cannabis, more people than ever are turning to CBD oil as a natural alternative for their ailments. In this article, we’re going to shed light on scientific research concerning the potential use of CBD oil for cancer and its symptoms.
We’ll also provide our list of recommended CBD oils that could potentially help individuals on their way to safe recovery.
CBD Oil for Cancer-related Symptoms
There is limited research into CBD’s potential as a treatment for cancer and its symptoms. The FDA refuses to acknowledge CBD oil as a treatment for cancer; there’s only one pharmaceutical containing cannabidiol — its name is Epidiolex. However, Epidiolex is reserved for epilepsy patients, not those struggling with cancer.
If you want to use CBD oil for cancer, make sure to make an appointment with a doctor first; doing so will give you a fuller image of how CBD oil could help your treatment.
While CBD isn’t a cure-all, it can surely help you ease several of its symptoms as well as some adverse reactions to chemotherapy and radiation.
Here’s what studies have found when it comes to using CBD oil for cancer.
Researchers have proposed CBD as a natural resource to reduce nausea and vomiting due to how it interacts with the brain. Many patients regularly use cannabinoids to calm the uncomfortable sensation of nausea as an unwanted effect of chemotherapy, radiation, and anti-cancer medications. Moreover, CBD regulates serotonin levels, which can reduce the stimulation in the brain’s area responsible for vomiting.
In a 2015 study conducted by Care By Design, most patients who took CBD oil for pain and inflammation reported improvements in their symptoms. CBD acts on specific pathways in the brain that may reduce inflammation and block pain signals. Pain is one of the most troubling symptoms of cancer — and a side effect of chemotherapy — so these are very promising results for those suffering from cancer.
Fatigue and Sleep Disturbances
CBD is an adaptogen, meaning they can help the body maintain homeostasis within the body without negatively impacting its functioning as well as making any changes in the brain structure. Adaptogens are also classified as smart molecules because they can act exactly where they are needed to promote balance and strengthen regeneration processes, such as neurogenesis. When cancer patients suffer from a lack of sleep, CBD may help ease some of the stress and anxiety that are often associated with this condition. This can help the body regulate its sleep cycles.
CBD may also help target the specific processes in the body to provide it with enough energy and vitality, which can be useful for cancer patients after chemotherapy. On top of the above, it can also improve focus. Some scientists refer to CBD as “the boy scout molecule” because it always reaches the right target in any given situation.
Loss of Appetite
Although some individuals report appetite suppression after using CBD, it turns out it may have an opposite effect on others. When CBD reaches specific receptors in the brain, it can improve your appetite. And since the majority of cancer patients suffer from loss of appetite, this particular trait of CBD oil may come in handy when it comes to helping the body’s needs for nourishment, which the body needs throughout the disease and after radiation.
Can CBD Oil Help Cure Cancer?
There’s a lot of anecdotal evidence floating online from people claiming they have been cured of cancer by using cannabis. Scientific research performed on animals has shown that CBD can shrink tumors and stop them from spreading. For example, a research paper from 2011 showed that the stimulation of cannabinoid receptors through a mix of cannabinoids and fatty acids could potentially relieve prostate tumors.
Another study published in Plus One highlighted CBD’s anti-cancer properties to trigger a process of apoptosis — the death of cancerous cells — preventing tumor growth by reducing the number of certain proteins that are involved in the spread of malignant cells. The researchers concluded that they would recommend CBD as an anti-cancer agent due to its safety and lack of life-threatening side effects.
We’ve also visited the Cure your Own Cancer site, where patients provide their testimonials about their success in treating cancer with cannabis oil. The website was founded by a young activist Lincoln Horsley and it shares a lot of free information about cannabis, cancer, and how products like CBD oil can be used to support individuals on their way to recovery.
With all that said, using CBD oil for cancer isn’t an approved treatment because there haven’t been many human trials regarding this issue. Therefore, consumers must keep in mind that while anecdotal evidence about CBD oil and cancer is very optimistic, it must be scientifically investigated before being approved as a treatment method.
Best CBD Brands for Cancer Aid
The following compilation is a summary of CBD oils that we’ve selected after analyzing over 40 brands from local stores and online retailers. They have been evaluated according to the quality criteria such as hemp source, extraction methods, third-party testing, and customer service.
1. Royal CBD (Most Potent)
Get 15% off all Royal CBD products. Use code “CFAH” at checkout.
|Potency||250 mg –2500 mg|
|Available Flavors||Natural, Berry, Mint, Vanilla|
|CBD per serving||8.3 mg – 83.3 mg|
Why Royal CBD is the Best CBD Oil for Cancer
My story with Royal CBD started about two years ago when we first read about them in one of our news briefs. They attracted us with the simplicity of their product selection, with only a few full-spectrum CBD oils available for sale. After two years, the company has grown by miles and expanded its line with capsules, gummies, and topicals — also adding a high-potency option to their oils.
Since then, Royal CBD oil has been our number one product.
Royal CBD oils come in four different potency options, including 250 mg, 500 mg, 1000 mg, and 2500 mg. You can choose from flavors like Mint, Berry, and Vanilla, save for the highest strengths, which only comes in the unflavored version. These are full-spectrum products, meaning they were made using the whole plant and contain all the non-psychoactive cannabinoids and terpenes originally found in hemp. I’ve noticed the best results when it comes to nausea and pain relief using the 2500 mg bottle. The oil has also helped calm my anxiety and improved sleep.
Note: Royal CBD is only available online; you won’t find it in any local store, although their online shop offers great discounts and a loyalty program that lets you save money on their products.
- Sourced from locally grown organic hemp
- Extracted with supercritical CO2
- Contains full-spectrum CBD
- Available in 4 potencies and flavors
- Up to 2500 mg of CBD per bottle
- Only available online
2. Gold Bee (Best Flavor)
|Potency||1200 mg – 2400 mg|
|Available Flavors||Natural, Kiwi, Lychee|
|CBD per serving||40 mg – 80 mg|
About Gold Bee
Gold Bee is a Nevada-rooted brand that focuses on making honey-flavored CBD extracts. The company has developed its own blend of high-CBD strains in partnership with local growers from Colorado. These plants are grown from non-GMO seeds in healthy soils and without growth boosters or pesticides.
Aside from the premium quality of ingredients, I believe this brand deserves much appreciation for how they mix CBD with honey. The flavor is surprisingly natural and masks the earthy hemp aftertaste that you get from full-spectrum CBD oil.
About the effects, I noticed similar results with my anxiety and pain to what I got from Royal CBD oil, but due to the lack of high-potency oil in its selection, I’ve decided to give the guys at Gold Bee second place.
However, if low-to-moderate doses of CBD work for you, this is one of the best brands to purchase CBD oil from.
- Made from US-grown organic hemp
- Infused with full-spectrum CBD
- Up to 80 mg CBD/mL
- Decent potency range for beginners
- Third-party tested for potency and purity
- Delicious honey + kiwi and honey + lychee flavor
- No low-potency oils in their collection
3. CBDPure (Best Transparency)
|Potency||100 mg –1000 mg|
|CBD per serving||3.3 mg – 33 mg/mL|
CBDPure specializes in making mostly low-potency CBD oil. Recently, the brand has added a 1000 mg potency to their collection, which we simply couldn’t miss.
One interesting thing about CBDPure is that its low-potency oils work better than some high-potency products I’ve tried so far. For me, CBDPure is a textbook example of how to make top-of-the-shelf full-spectrum extracts. The effects were very similar to what I’ve experienced with the other two companies in this ranking.
CBDPure is my third-best pick on this list because both Royal CBD and Gold Bee offer a better price/quality ratio.
- Made from organic Colorado-grown hemp
- Extracted with supercritical CO2
- Lab-tested for CBD content and purity
- Contains full-spectrum CBD
- 90-day return policy
- Only two types of product available
- Low strength
- More expensive than the competition
4. Hemp Bombs (Best CBD Isolate)
|Potency||125 mg – 4000 mg|
|Available Flavors||Natural, Acai Berry, Orange Creamsicle, Peppermint, Watermelon|
|CBD per serving||4 – 133 mg/mL|
About Hemp Bombs
Hemp Bombs is an American manufacturer that produces CBD oil made from 99% pure isolate. The company offers an extensive range of CBD extracts, offering up to 4000 mg of total CBD. This CBD oil is an excellent choice for cancer patients who, for some reason, want to avoid any THC in their oil. Full-spectrum products contain 0.3% THC or less, which isn’t enough to get anyone high, but CBD isolate is 100% THC-free.
CBD isolate is also odorless and flavorless, so it’s a good alternative for those who have problems with holding full-spectrum extracts in their mouth. That being said, there’s no synergy from other cannabinoids and terpenes, so Hemp Bombs may not be the best choice for those looking for the entourage effect in cannabis.
- Sourced from organic hemp
- Extracted with supercritical CO2
- Available as broad-spectrum or isolate
- Third-party tested for CBD and purity
- Up to 4000 mg of total CBD
- 5 strengths to choose from
- Infused with synthetic flavorings
- No synergy from other cannabinoids and terpenes
- Most people don’t need such high-potency oils in their routine
5. CBDistillery (Best Price)
|Potency||250 mg – 5000 mg|
|Potency||8.3 – 166 mg/mL|
CBDistillery is one of the largest CBD companies in North America. The brand was launched by a group of Colorado citizens based on a mutual goal to supply consumers with affordable products that still match the highest quality standards. CBDistillery’s products are available in an extremely wide range of potencies, from 250 mg to a whopping 5000 mg of CBD per bottle. The highest potency contains 166 mg of CBD in each milliliter, which is enough to get yourself a few month’s worths of supplies.
You can also choose which type of CBD extract you want in your oil because CBDistillery offers both full-spectrum and broad-spectrum extracts (pure CBD oil). In the broad-spectrum variant, THC has been completely removed after initial filtration, but the other cannabinoids and terpenes from hemp have been preserved.
CBDistillery has scored the last place in your compilation of the best CBD oils for cancer due to their hemp sourcing practices — the plants used by the company are non-GMO but not certified organic.
- Available as full-spectrum or broad-spectrum CBD
- Extracted with CO2
- 5 strengths to choose from
- Up to 166.6 mg of CBD per bottle
- Third-party tested for potency and purity
- Very affordable
- Their hemp isn’t organic
- No flavored options
What is CBD?
CBD is one of over 100 compounds in cannabis plants, which are categorized as cannabinoids. Unlike its psychoactive cousin THC, CBD can’t make you feel high. However, it still offers a plethora of benefits for our health.
It turns out that all mammals have an endocannabinoid system (discovered in the 1990s), which is a prime self-regulatory network composed of cannabinoid receptors and neurotransmitters known as endocannabinoids. Endocannabinoids are chemical messengers that are released to maintain homeostasis in the body, which is a state of equilibrium between all bodily functions, such as pain signaling, appetite, sleep cycles, immune function, emotional processing, and more.
CBD acts as a modulator, meaning it signals the endocannabinoid system to produce and maintain more of its native cannabinoids to help them effectively maintain the balance within the body.
CBD can also help the endocannabinoid system regain its proper functioning when homeostasis has been disrupted. Through the said signaling, it can promote the formation of healthy cells in the body while turning on the process of apoptosis — the destruction of malignant cells.
People use CBD for a wide range of health problems, from common anxiety to inflammatory conditions and severe chronic diseases, such as osteoarthritis, epilepsy, Autism Spectrum Disorders, and cancer.
What is CBD Oil?
CBD oil is a liquid extract that contains high concentrations of CBD. It is made using hemp flowers, the resinous part of the plant. After initial extraction, CBD oil usually undergoes filtration to dump the redundant plant material and suspend the extract in a food-grade carrier oil, such as hemp seed oil or MCT oil.
CBD oil comes in glass bottles with a dropper attached for easier and precise dosing. To take CBD oil, you need to use the dropper to measure out the dose and place the oil beneath your tongue, allowing it to sit there for about one minute to let it absorb through special membranes in the mouth. You can swish it around the mouth to increase the surface area and increase the oil’s bioavailability.
Is CBD Oil Legal?
CBD can be produced from hemp and marijuana, so it’s understandable that you may have questions about its legality.
Marijuana-derived CBD oil will contain a considerable amount of THC, which crosses the legal 0.3% barrier. Such products can get the user high and are legal only in states that legalized recreational marijuana use. In states with a medical marijuana program, you can apply for a medical marijuana card to purchase marijuana-derived CBD oil from one of the state-licensed dispensaries.
Hemp is legal on the federal level because it contains up to 0.3% THC, which can do anything but produce a psychoactive buzz. In 2018, hemp was removed from the list of controlled substances. Hemp-derived CBD oil can be found over the counter in pharmacies, dispensaries, fitness studios, local health stores, and online. It’s a plant-based supplement, so you don’t need a prescription for it.
Final Thoughts on Using CBD Oil for Cancer
Researchers agree that cancer patients could benefit from CBD oil to some extent, but there is still much we don’t know about the exact mechanism behind its anti-cancer potential. Therefore, it’s too early to draw any conclusions.
Fortunately, CBD has garnered much attention from the medical community lately, and scientists are willing to further investigate its effects on cancer, its symptoms, and the side effects of chemotherapy. For instance, the Spanish Observatory on Medical Cannabis is aggressively researching cancer treatment with cannabis extracts, regularly posting their findings on its website.
If you want to try CBD oil to support your well-being during your cancer treatment and ease some of the uncomfortable side effects of chemotherapy, consult your doctor about it, and above all, always buy your CBD oil from a reputable source that can provide premium-quality ingredients proven by lab-testing reports.
Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.
Using cannabis in prostate cancer patients
In our hospital’s daily practice we notice the popular use of cannabis oil in prostate cancer (PCa) patients. As a nursing specialist for urology, I have even met patients who are so convinced of the curative benefits of cannabis oil in treating prostate cancer that they replace standard treatment with the use of cannabis oil.
These patients include those who have localised prostate cancer where active surveillance is followed, those with biochemical recurrence after treatment, and patients with metastatic PCa. I have always wondered whether cannabis oil could indeed be a cure for prostate cancer. Unfortunately, I do not see in practice the desired beneficial effect and the PSA values continue to rise. To find some answers, I did a search in scientific literature.
Cannabis, a very easy plant to grow, has been used for centuries for its medicinal properties. The oldest known document about cannabis use originates from the Chinese emperor Shen Nung in 2727 B.C. It suggested that cannabis has a neuron-protective effect. The Egyptians used cannabis to treat glaucoma and as an anti-inflammatory agent (inflammation of the eyes, fever). Cannabis was even used in obstetrics (mixed with honey) and the mixture was applied in the vagina to “cool” the uterus. In the Old Testament, there is also an account of God instructing Moses to make a holy anointing olive oil-based “Kaneh Bosm.”
Cannabis contains more than 400 chemical components 80 of which contain cannabinoid components and 200 non-cannabinoids components. For medical purposes, cannabinoid substances such as THC (Delta-9-tertrahydrocannabinol), CBD (cannabidiol) and non-cannabinoid substances such as terpenoids and flavonoids are relevant.
Medicinal cannabis must be distinguished from recreational cannabis which is used to achieve a psychotomimetic state of ‘high’. Cannabis strains used for recreational purposes contain a higher THC and lower CBD ratio than cannabis for medicinal use. Usually two cannabis plants are used: cannabis sativa which has a higher THC concentration and cannabis indica which has a higher CBD concentrate. The flavonoids are known for their antioxidant and anti-inflammatory effects. The terpenoids are resins (oil) with a strong odour.
In the 1990s, the endocannabinoid system (ESC) of the body was discovered by Raphael Mechoulam, an Israeli professor of medical chemistry. The endocannabinoid system, a central regulatory system, is the body’s largest receptor system and is important to maintain the homeostasis of the body.
Human beings produce their own cannabinoids (endocannabinoids) according to need and are not stored in the body. Like endorphins, the human body produces endocannabinoids in response to activities such as physical exercise (the high of runners might be due to endocannabinoids, not endorphins!).
Cannabinoid receptor type 1 (CB1) is mainly found in the brain, and also in the lungs, the reproductive organs, etc. Cannabinoid receptor type 2 (CB2) is usually located in the immune system and in the bones. THC mainly works on CB1 receptors, CBD on CB2 receptors.
In vitro studies with THC have shown that cannabinoids affect migration, angiogenesis and apoptosis (programmed cell death) of cancer cells, but each type of cancer appears to respond differently to the effect of exogenous cannabinoids. Many types of cancer cells have a higher concentration of CB1 and CB2 receptors.
Use of cannabis in cancer
– Pain: Cannabinoids have been used for centuries to lessen pain. Historical texts and old pharmacopoeia noted the use of cannabis for menstrual cramps, pain during childbirth, and headaches. Studies have shown that the cannabinoids have no effect on acute pain and post- operative pain. Two placebo-controlled studies with a cannabis extract showed modest benefits when using cannabinoids in addition to opioids and other adjuvant pain-killers in cancer patients with chronic pain. However, the effect of cannabinoids in chronic neuropathic pain was clearly demonstrated in 29 randomized studies.
– Nausea and vomiting: An initial study in 1975 showed a beneficial effect of THC on nausea induced by chemotherapy. Subsequently, two systematic reviews showed benefits of cannabinoids in nausea and vomiting due to chemotherapy, but most studies were observational or uncontrolled.
– Stimulation of appetite: Cannabinoids seem to have only a modest effect in cancer patients with cachexia. More promising results were seen in studies in the population without cancer.
– Pre-clinical studies (in vitro = cells in laboratory and in vivo = in mouse model) have shown the antiproliferative, anti-metastatic, anti-angiogenic and pro-apoptotic effects of cannabinoids in various malignancies (lung, glioma, thyroid, lymphoma, skin, pancreas, endometrium, breast and prostate). Even if an identified substance in vitro / in vivo appears to have a beneficial effect on a disease, it is important to realise that only one in 5,000-500,000 substances obtain a registration and becomes available to the patient (after 10-16 years of different study phases). Cannabis has never been clinically studied as a treatment for malignancy.
On the Internet, patients can get a lot of information about the curative effect of cannabis oil on prostate cancer but this information extrapolate the results of pre-clinical work to possible effects in people without any factual evidence. I often see patients in the doctor’s office showing me a website where it has been proven that cannabis oil can cure prostate cancer, which is obviously their own interpretation. In my view this can be a misleading message even though the website does not explicitly provide false information. The website [See figure below] shows information which is based on a study published in the British Journal of Cancer. This is correct, but the website “neglects” to mention that this is a publication of an in vitro study. The patient might not even know what an in vitro study is and is not aware that there are no studies on humans yet to prove this.
A challenge for the caregiver can be that the patient is convinced that we as healthcare practitioners work together with the pharmacists, and that we do not wish to carry out clinical trials (unfortunately, I hear that very often). We can hardly persuade patients that this is not true.
It is also important that we inform the patient about the possible interactions of cannabis oil with certain regular medications such as Coumarin (this blood thinner interacts with cannabis oil, leading to an increase of the INR and a greater risk of bleeding!). There are different types of cannabis oil available, such as CBD and THC oils with different concentrations which makes it difficult for patients to make a choice.
• There is no proof of cannabis oil as cure for prostate cancer;
• It is important not to be prejudiced or judgmental against patients who use cannabis oil;
• Listening to the patient’s view can be helpful since the patient often confides to the nurse rather than to their physicians;
• Avoid persuading patients not to use cannabis oil, but try to convince them of the need to follow a regular treatment combined with cannabis oil;
• Consider adverse interactions between cannabis oil and certain medications and inform your patient about these.
- Abrams, D.I. Integrating cannabis into clinical cancer care. Current Oncology, 23, S8-S14 (2016).
- Benzi Kluger, Piera Triolo, Wallace Jones, Joseph Jankovic. The Therapeutic Potential of Cannabinoids for Movement Disorders. Mov Disord. 2015 Mar; 30(3):313–327.
- Bowles, D.W, O’Brien, C.L, Camidge D.R, Jimeno A. The intersection between cannabis and cancer in the U.S. Critical Reviews in Oncology/Hematology, 83, 1-10 (2012).
- Bridgeman M.B and Abazia D. T. Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting. P T. 2017 Mar; 42(3): 180–188.
- De Petrocellis L. et al. Non-THC cannabinoids inhibit prostate carcinoma growth in vitro and in vivo:pro-apoptotic effects and underlying mechanisms. Br J Pharmacol. 2013 Jan; 168(1): 79–102.
- Guindon, J. Hohmann, A.J. The Endocannabinoid System and Cancer.: Therapeutic Implication. British Journal of Pharmacology. 163, 14447-1463 (2011) – Johnson J.R et al. Multicenter, dubbel blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety and tolerability of THC: CBD extract and THC extract in patients with intractable cancerrelated pain. J.Pain Symptom Manage 2010;39:167-79.
- Machado Rocha F.C. et al. Therapeutic use of Cannabis Sativa on chemotherapy-induced nausea and vomiting among cancer patients: systematic review and meta-analysis. Eur. J. Cancer Care 2008;17:431-43.
- Olea-Herrero N. et al. Inhibition of human tumour prostate PC-3 cell growth by cannabinoids R(+)-Methanandamide and JWH-015: Involvement of CB2. British Journal of Cancer volume 101, pages 940–950 (15 September 2009).
- Portenoy R.K et al. Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded dose trial. J. Pain 2012;13:438-49.
- Ramos J.A. et al. The role of cannabinoids in prostate cancer: Basic science perspective and potential clinical applications. Indian J Urol. 2012 Jan-Mar; 28(1): 9–14.
- Tramer M.R. et al. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 2001;323:16-21.
Corinne Tillier, Nurse Practitioner Urology, Antoni van Leeuwenhoek Hospital, Amsterdam (NL), [email protected]