When taking orally, such as through CBD oil, the general rule is to start with a low dosage and very gradually increase as needed. As of now, there are no well-established dosing guidelines for CBD. If well tolerated by the patient, oral ingestion can be particularly helpful with relieving chronic pain, though it is important to keep in mind there may be psychoactive effects. A CBD dosage of 5-20mg/day may provide some benefit, and it may be helpful to take throughout the day – for example, if taking 10mg in total, divide into doses of 3mg three times per day, or 5mg twice per day.
The prevailing recommendation is to start low, go slow, and stay low; and the best dose is the one that is lowest you can take and still get some relief and can tolerate. Questions to ask during a consultation are:
Today, medical cannabis is legal in several states, but varies widely by jurisdiction, and its legislative status is ever-evolving. For those interested in potential use of medical cannabis for ovarian cancer, a good first step is to consult with your physician about the regulations for your area, as well as, of course, whether medical cannabis is right for you.
The Cannabis plant has many properties that either interact with the cannabinoid receptors in our bodies or share chemical similarities with our own system, among them pain relief, anti-anxiety, anti-seizure, anti-nausea, anti-inflammatory, antioxidant, anti-tumor, as well as neuroprotective effects. The most studied of the cannabinoids are THC and CBD. THC has a strong effect on our nervous system, but weak on our immune, and has psychoactive effects. CBD, on the other hand, has both weak effects on our nervous and immune systems, without psychoactive effects.
As with any supplemental treatment, it is very important to discuss CBD in detail with your doctor or medical team before using, to ensure no adverse effects connected to chemotherapy or your own individual health needs. CBD can be harmful when used in individuals with certain health conditions, such as high blood pressure, cardiological or pulmonary conditions, allergies, and more, and can also interact poorly with certain drugs. It is important to be safe when considering trying CBD to manage side effects from ovarian cancer and its treatment.
Can CBD Help With Ovarian Cancer?
The trick, depending on the symptom, is in finding the right balance between the two most commonly used cannabinoids, the right dosage, and the right delivery method. People can inhale cannabis; take it orally via lozenges, sprays, edibles or capsules; absorb it through their skin with a cream; or take it rectally. Each delivery method varies in terms of the onset and duration of relief and comes with its own considerations and contraindications.
Marijuana. CBD. Weed. Pot. Ganja. Devil’s Lettuce. It’s remarkable that a single plant can have so many monikers, and so many medicinal uses. Kelay Trentham, a Registered Dietitian Nutritionist and Board Certified Specialist in Oncology Nutrition, spoke at OCRA’s Ovarian Cancer National Conference last year about how medical cannabis can be used in the treatment of ovarian cancer. Here’s what she shared.
In this case report, we highlight a dramatic response to combination Laetrile and CBD oil in a patient with widely metastatic LGSOC. Laetrile is a semi-synthetic version of amygdaline, a chemical compound found in plants and fruit seeds. Both Laetrile and amygdaline contain cyanide within a common structural component. Theoretically, Laetrile has anti-cancer effects when cyanide is released via enzymatic degradation. However, a Cochrane review published in 2015 found no randomized or quasi randomized control trials supporting the use of Laetrile in cancer patients (Milazzo, 2015). Further, they argued that due to the risk of cyanide poisoning, Laetrile use should be discouraged in patients seeking the compound for alternative cancer therapy. Concerns for toxicity in combination with inability to demonstrate clinical efficacy led to an effective ban on the substance by the FDA in the 1980s. Nevertheless, the substance remains available for purchase in variable formulations commercially.
Perhaps most provocative is the recent report that 40% of Americans believe that use of CAM is sufficient for the management of cancer (National Cancer Opinion Survey, 2019). In addition, 22% of Americans with a history of a cancer diagnosis and 38% of family caregivers share this belief. However, a recent study evaluated overall survival and adherence to treatment in patients receiving conventional cancer treatment with or without CAM for cancers considered curable. Patients who used CAM had significantly decreased overall survival when compared to those who did not, and also had higher rates of refusal of standard therapy (Johnson et al., 2018). Notably, this risk of death is linked to the refusal of therapy and not to the use of CAM itself. This demonstrates the importance and need for transparent, open discussions with patients regarding current available therapies, expected outcomes, and alternatives that patients may be seeking or have not yet disclosed.
Cannabidiol (CBD) is a compound naturally derived from the cannabis plant. The anti-cancer effects of CBD have been evaluated predominantly in the laboratory setting. Interestingly, ovarian cancer cell lines express GPR55, a target that is inhibited indirectly by CBD and that plays a role in prostate and ovarian cancer cell proliferation (Piñeiro et al., 2011). Mouse model studies have also demonstrated cannabinoids inhibit tumor cell growth and induce apoptosis in gliomas, lymphomas, prostate, breast, lung, skin, and pancreatic cancer cells (Sarfaraz et al., 2008). Despite this theoretical benefit, there is not clear evidence that it has more or less activity than standard treatments in cancer patients.
Low grade serous ovarian cancer (LGSOC) is a rare subtype of serous epithelial ovarian cancer, comprising approximately 10% of all cases of serous carcinoma. The majority of women are diagnosed with advanced stage disease, despite its slow growth. Treatment options for advanced disease include neoadjuvant chemotherapy followed by interval surgical cytoreduction or primary surgical resection followed by adjuvant therapy as well as maintenance hormonal therapy (National Comprehensive Cancer Network, 2019). Adjuvant therapy traditionally consists of combination platinum and taxane based chemotherapy, although response rates are limited, and may include concurrent/maintenance hormonal therapy. Even with advanced stage at diagnosis, patients with LGSOC have an improved prognosis when compared to their high grade serous counterparts, with median overall survival of approximately 100 months reported, reflective of a protracted clinical course (Gershenson et al., 2015).
In July 2017, CT imaging was repeated and she was found to have a decrease in the size of the bilateral adnexal masses and mesenteric and pelvic lymphadenopathy, which was confirmed by clinical exam. Her mesenteric and omental carcinomatosis remained stable. Genomic profiling of her primary surgical specimen was ordered at this time and no molecular aberrations were identified. She was seen for follow up in September 2017, four months after starting initial treatment, and repeat imaging in November 2017 continued to show a dramatic reduction in her disease burden, with near complete resolution of all previously identified lesions ( Fig. 3 ). On her most recent interval assessment in December 2018 she continues to show a response to therapy. She is clinically asymptomatic with a performance status of 0, which is unchanged from her performance status at time of diagnosis.
CT scan May 2017, illustrating a right adnexal mass measuring 5.8 cm × 5.0 cm.
In an effort to improve oncologic outcomes, investigators have attempted to capitalize on molecular aberrations identified in LGSOC specimens. Most recently, the utilization of MEK inhibitors have been explored due to noted activation of the mitogen-activate protein kinase (MAPK) pathway in LGSOC. A phase II trial evaluating Selumatib activity in women with recurrent LGSOC (GOG 0239) demonstrated a 15% overall response rate, catalyzing the development of phase III trials examining alternate agents in this setting (Farley et al., 2013). A phase III study evaluating Trametinib vs. physicians choice chemotherapy in patients with recurrent or progressive LGSOC (GOG-281) has closed to accrual and will help guide further management with these targeted agents. Furthermore, efforts to identify appropriate patient subsets based on molecular profiling are ongoing. In context of the above, optimal management of these relatively chemotherapy-resistant tumors due to their low-grade nature remains an active area of investigation.
An 81-year-old woman presented to her primary care physician with an umbilical mass that was suspected to be a hernia in March 2017. She was taken to the operating room in April 2017 for planned herniorrhaphy. The surgical findings were notable for a solid, peri-umbilical mass, as well as diffuse intra-abdominal nodularity. Final pathology of the resected umbilical lesion demonstrated a serous carcinoma, likely mullerian primary based on immunohistochemistry staining. Her Ca-125 was found to be elevated at 77.
In this case report, we present a woman with LGSOC who declined primary systemic chemotherapy followed by interval surgical resection and opted for CAM therapy with Laetrile (amygdalin) and cannabidol (CBD) oil. The patient has granted permission for this publication.