http://www.cancer.gov/about-cancer/treatment/cam/patient/cannabis-pdq/#link/_13Have any preclinical (laboratory or animal) studies been conducted using Cannabis or cannabinoids?
Preclinical studies of cannabinoids have investigated the following:
Antitumor activity
Studies in mice and rats have shown that cannabinoids may inhibit tumor growth by causing cell death, blocking cell growth, and blocking the development of blood vessels needed by tumors to grow. Laboratory and animal studies have shown that cannabinoids may be able to kill cancer cells while protecting normal cells.
A study in mice showed that cannabinoids may protect against inflammation of the colon and may have potential in reducing the risk of colon cancer, and possibly in its treatment.
A laboratory study of delta-9-THC in hepatocellular carcinoma (liver cancer) cells showed that it damaged or killed the cancer cells. The same study of delta-9-THC in mouse models of liver cancer showed that it had antitumor effects. Delta-9-THC has been shown to cause these effects by acting on molecules that may also be found in non-small cell lung cancer cells and breast cancer cells.
A laboratory study of cannabidiol (CBD) in estrogen receptor positive and estrogen receptor negative breast cancer cells showed that it caused cancer cell death while having little effect on normal breast cells. Studies in mouse models of metastatic breast cancer showed that cannabinoids may lessen the growth, number, and spread of tumors.
A laboratory study of cannabidiol (CBD) in human glioma cells showed that when given along with chemotherapy, CBD may make chemotherapy more effective and increase cancer cell death without harming normal cells. Studies in mouse models of cancer showed that CBD together with delta-9-THC may make chemotherapy such as temozolomide more effective.
Stimulating appetite
Many animal studies have shown that delta-9-THC and other cannabinoids stimulate appetite and can increase food intake.
Pain relief
Cannabinoid receptors (molecules that bind cannabinoids) have been studied in the brain, spinal cord, and nerve endings throughout the body of animals to understand their roles in pain relief.
Cannabinoids have been studied for anti-inflammatory effects that may play a role in pain relief.
Animal studies have shown that cannabinoids may prevent nerve problems (pain, numbness, tingling, swelling, and muscle weakness) caused by some types of chemotherapy.
Nausea and vomiting
Cannabinoid receptors found in brain cells may have a role in controlling nausea and vomiting. Animal studies have shown that delta-9-THC and other cannabinoids may act on cannabinoid receptors to prevent vomiting caused by certain types of chemotherapy.
Anxiety and sleep
Cannabinoid receptors found in the brain and other parts of the nervous system may be involved in controlling mood and anxiety.
Anti-anxiety effects of cannabidiol (CBD) have been shown in several animal models.
Have any clinical trials (research studies with people) of Cannabis or cannabinoid use by cancer patients been conducted?
No clinical trials of Cannabis as a treatment for cancer in humans have been found in the CAM on PubMed database maintained by the National Institutes of Health.
Cannabis and cannabinoids have been studied in clinical trials for ways to manage side effects of cancer and cancer therapies, including the following:
Cancer
Cannabidiol (CBD) by mouth to treat solid tumors.
An oral spray combining 2 cannabinoids (delta-9-THC and CBD) given with temozolomide to treat recurrent glioblastoma multiforme.
Cannabidiol (CBD) to treat acute graft-versus-host disease in patients who have undergone allogeneic hematopoietic stem cell transplantation.
Nausea and vomiting
Delta-9-THC taken by mouth: Two cannabinoid drugs approved in the United States are available under the names dronabinol and nabilone. Both dronabinol and nabilone are approved by the Food and Drug Administration (FDA) for the treatment of chemotherapy-related nausea and vomiting in patients who have not responded to standard therapy. Many clinical trials have shown that both dronabinol and nabilone worked as well as or better than some of the weaker FDA-approved drugs to relieve nausea and vomiting. Newer drugs given for chemotherapy-related nausea have not been directly compared with Cannabis or cannabinoids in cancer patients.
Inhaled Cannabis: Ten small trials have studied inhaled Cannabis for the treatment of chemotherapy-related nausea and vomiting. Various study methods and chemotherapy agents were used with mixed results. There is not enough information to interpret these findings.
Oral spray with delta-9-THC and cannabidiol (CBD): Nabiximols, a Cannabis extract given as a mouth spray, was shown in a small randomized, placebo-controlled, double-blinded clinical trial in Spain to treat chemotherapy-related nausea and vomiting.
There is growing interest in treating children for symptoms such as nausea with Cannabis and cannabinoids, although studies are limited. The American Academy of PediatricsExit Disclaimer has not endorsed Cannabis and cannabinoid use because of concerns about brain development.
Stimulating appetite
Delta-9-THC taken by mouth: A clinical trial compared delta-9-THC (dronabinol) and a standard drug (megestrol) in patients with advanced cancer and loss of appetite. Results showed that delta-9-THC was not as effective in increasing appetite or weight gain in advanced cancer patients compared with standard therapy. However, a clinical trial of patients with HIV /AIDS and weight loss found that those who took delta-9-THC had increased appetite and stopped losing weight compared with patients who took a placebo.
Inhaled Cannabis: There are no published studies of the effect of inhaled Cannabis on cancer patients with loss of appetite. Studies of healthy people who inhaled Cannabis showed that they consumed more calories, especially high-fat and sweet snacks.
Pain relief
Combining cannabinoids with opioids: In a small study of 21 patients with chronic pain, combining vaporized Cannabis with morphine relieved pain better than morphine alone, while combining vaporized Cannabis with oxycodone did not produce significantly greater pain relief. These findings should be tested in further studies.
Delta-9-THC taken by mouth: Two small clinical trials of oral delta-9-THC showed that it relieved cancer pain. In the first study, patients had good pain relief as well as relief of nausea and vomiting and better appetite. A second study showed that delta-9-THC could be given in doses that gave pain relief comparable to codeine. An observational study of nabilone also showed that it relieved cancer pain along with nausea, anxiety, and distress when compared with no treatment. Neither dronabinol nor nabilone is approved by the FDA for pain management.
Cannabis plant extract medicine: A study of an extract of Cannabis that contained specific amounts of cannabinoids, which was sprayed under the tongue, found it was effective in patients with advanced cancer whose pain was not relieved by strong opioids alone. Patients who received the lower doses of cannabinoid spray showed markedly better pain control and less sleep loss compared with patients who received a placebo. Results showed that, for some patients, control of their cancer-related pain continued without needing higher doses of spray or higher doses of their other pain medicines.
Anxiety and sleep
Inhaled Cannabis: A small case series found that patients who inhaled Cannabis had improved mood, improved sense of well-being, and less anxiety.
Have any side effects or risks been reported from Cannabis and cannabinoids?
Adverse side effects of cannabinoids may include:
Rapid beating of the heart.
Low blood pressure.
Muscle relaxation.
Bloodshot eyes.
Slowed digestion and movement of food by the stomach and intestines.
Dizziness.
Depression.
Hallucinations.
Paranoia.
Because Cannabis smoke contains many of the same substances as tobacco smoke, there are concerns about how inhaled cannabis affects the lungs. A study of over 5,000 men and women without cancer over a period of 20 years found that smoking tobacco was linked with some loss of lung function but that occasional and low use of cannabis was not linked with loss of lung function.
Because use of Cannabis over a long time may have harmful effects on the endocrine and reproductive systems, rates of testicular germ cell tumors (TGCTs) in Cannabis users have been studied. Larger studies that follow patients over time and laboratory studies of cannabinoid receptors in TGCTs are needed to find if there is a link between Cannabis use and a higher risk of TGCTs.
A review of bladder cancer rates in Cannabis users and non-users was done in over 84,000 men who took part in the California Men's Health Study. Over 16 years of follow-up and adjusting for age, race/ethnic group and body mass index (BMI), rates of bladder cancer were found to be 45% lower in Cannabis users than in men who did not report Cannabis use.
Both Cannabis and cannabinoids may be addictive.
Symptoms of withdrawal from cannabinoids may include:
Irritability.
Trouble sleeping.
Restlessness.
Hot flashes.
Nausea and cramping (rarely occur).
These symptoms are mild compared to withdrawal from opiates and usually lessen after a few days.