Cannabinoid and Cancer / JUNIO 2017

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Cannabinoids and Cancer

1. 

The psychoneuroendocrine-immunotherapy of cancer: Historical evolution and
clinical results.

Lissoni P(1), Messina G(1), Lissoni A(1), Franco R(1).

Author information: 
(1)Department of Clinical Oncology, International Institute of
Psychoneuroendocrineimmunology, Milan, Italy.

The prognosis of the neoplastic diseases depends not only on the biogenetic
characteristics of cancer cells but also on the immunological response of
patients, which may influence the biological features of cancer cells themselves 
as well as the angiogenic processes. Moreover, the immune system in vivo is under
a physiological psychoneuroendocrine (PNE) regulation, mainly mediated by the
brain opioid system and the pineal gland. In more detail, the anticancer immunity
is stimulated by the pineal hormone melatonin (MLT) and inhibited by the opioid
system, namely, through a mu-opioid receptor. Several alterations involving the
pineal endocrine function and the opioid system have been described in cancer
patients, which could play a role in tumor progression itself. Therefore, the
pharmacological correction of cancer progression-related anomalies could
contribute to control cancer diffusion, namely, the pineal endocrine deficiency
and the hyperactivity of brain opioid system. In fact, the administration of
pharmacological doses of the only MLT has already been proven to prolong the
1-year survival in untreatable metastatic cancer patients. Better results may be 
achieved by associating other pineal indoles to MLT, mu-opioid antagonists,
cannabinoids, beta-carbolines. Moreover, these neuroendocrine combinations may be
successfully associated with antitumor cytokines, such as interleukin (IL)-2 and 
IL-12, as a PNE-immune cancer therapy as well as with antitumor plants as
PNE-phytotherapy of cancer in an attempt to propose possible anticancer
treatments also to patients with disseminated cancer and untreatable according to
the standard oncology.

2. Cannabis and Cannabinoids (PDQ®): Patient Version.

PDQ Integrative, Alternative, and Complementary Therapies Editorial Board.
In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer
Institute (US); 2002-.
2017 Apr 13.

This PDQ cancer information summary has current information about the use of
Cannabis and cannabinoids in the treatment of people with cancer. It is meant to 
inform and help patients, families, and caregivers. It does not give formal
guidelines or recommendations for making decisions about health care. Editorial
Boards write the PDQ cancer information summaries and keep them up to date. These
Boards are made up of experts in cancer treatment and other specialties related
to cancer. The summaries are reviewed regularly and changes are made when there
is new information. The date on each summary ("Date Last Modified") is the date
of the most recent change. The information in this patient summary was taken from
the health professional version, which is reviewed regularly and updated as
needed, by the PDQ Integrative, Alternative, and Complementary Therapies
Editorial Board.
3. Cannabis and Cannabinoids (PDQ®): Health Professional Version.

PDQ Integrative, Alternative, and Complementary Therapies Editorial Board.
In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer
Institute (US); 2002-.
2017 Apr 7.

This PDQ cancer information summary for health professionals provides
comprehensive, peer-reviewed, evidence-based information about the use of
Cannabis and cannabinoids in the treatment of people with cancer. It is intended 
as a resource to inform and assist clinicians who care for cancer patients. It
does not provide formal guidelines or recommendations for making health care
decisions. This summary is reviewed regularly and updated as necessary by the PDQ
Integrative, Alternative, and Complementary Therapies Editorial Board, which is
editorially independent of the National Cancer Institute (NCI). The summary
reflects an independent review of the literature and does not represent a policy 
statement of NCI or the National Institutes of Health (NIH).

4. Anesth Analg. 2017 May 19. doi: 10.1213/ANE.0000000000002110. [Epub ahead of
print]

Selective Cannabinoids for Chronic Neuropathic Pain: A Systematic Review and
Meta-analysis.

Meng H(1), Johnston B, Englesakis M, Moulin DE, Bhatia A.

Author information: 
(1)From the *Department of Anesthesia and Pain Management, University Health
Network-Toronto Western Hospital, University of Toronto, Toronto, Ontario,
Canada; †Department of Anaesthesia and Pain Medicine and ‡Child Health Evaluative
Sciences, The Research Institute, The Hospital for Sick Children, Toronto,
Ontario, Canada; §Institute of Health Policy, Management and Evaluation, Dalla
Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;
‖Department of Clinical Epidemiology & Biostatistics, McMaster University,
Hamilton, Ontario, Canada; ¶Library and Information Services, Toronto General
Hospital, University Health Network, Toronto, Ontario, Canada; and #Department of
Clinical Neuro Sciences and Oncology Earl Russell Chair Pain Research, Western
University, London Regional Cancer Program, London, Ontario, Canada.

BACKGROUND: There is a lack of consensus on the role of selective cannabinoids
for the treatment of neuropathic pain (NP). Guidelines from national and
international pain societies have provided contradictory recommendations. The
primary objective of this systematic review and meta-analysis (SR-MA) was to
determine the analgesic efficacy and safety of selective cannabinoids compared to
conventional management or placebo for chronic NP.
METHODS: We reviewed randomized controlled trials that compared selective
cannabinoids (dronabinol, nabilone, nabiximols) with conventional treatments (eg,
pharmacotherapy, physical therapy, or a combination of these) or placebo in
patients with chronic NP because patients with NP may be on any of these
therapies or none if all standard treatments have failed to provide analgesia and
or if these treatments have been associated with adverse effects. MEDLINE,
EMBASE, and other major databases up to March 11, 2016, were searched. Data on
scores of numerical rating scale for NP and its subtypes, central and peripheral,
were meta-analyzed. The certainty of evidence was classified using the Grade of
Recommendations Assessment, Development, and Evaluation approach.
RESULTS: Eleven randomized controlled trials including 1219 patients (614 in
selective cannabinoid and 605 in comparator groups) were included in this SR-MA. 
There was variability in the studies in quality of reporting, etiology of NP,
type and dose of selective cannabinoids. Patients who received selective
cannabinoids reported a significant, but clinically small, reduction in mean
numerical rating scale pain scores (0-10 scale) compared with comparator groups
(-0.65 points; 95% confidence interval, -1.06 to -0.23 points; P = .002, I = 60%;
Grade of Recommendations Assessment, Development, and Evaluation: weak
recommendation and moderate-quality evidence). Use of selective cannabinoids was 
also associated with improvements in quality of life and sleep with no major
adverse effects.
CONCLUSIONS: Selective cannabinoids provide a small analgesic benefit in patients
with chronic NP. There was a high degree of heterogeneity among publications
included in this SR-MA. Well-designed, large, randomized studies are required to 
better evaluate specific dosage, duration of intervention, and the effect of this
intervention on physical and psychologic function.


5. Can Urol Assoc J. 2017 Mar-Apr;11(3-4):E138-E142. doi: 10.5489/cuaj.4371. Epub
2017 Apr 11.

Systematic review of the potential role of cannabinoids as antiproliferative
agents for urological cancers.

Gandhi S(1), Vasisth G(2), Kapoor A(2).

Author information: 
(1)Michael DeGroote School of Medicine, St Joseph's Hospital; Hamilton, ON,
Canada. (2)McMaster Institute of Urology, St Joseph's Hospital; Hamilton, ON,
Canada.

INTRODUCTION: The palliative effects of cannabis sativa (marijuana), which
include appetite stimulation, attenuation of nausea and emesis, and pain relief, 
are well known. The active components of cannabis sativa (cannabinoids) and their
derivatives have received growing interest due to their diverse pharmacological
activities, such as cell growth inhibition and tumour regression. The aim of this
review is to look at the current evidence on the antiproliferative effects of
cannabinoids in urological malignancies, including renal, prostate, bladder, and 
testicular cancers.
METHODS: We conducted a systematic review of studies exploring the effect of
cannabinoids on tumour activity, including all study types except expert
opinions. A formal search was run on Medline database from 1946 to September
2016, along with a hand-search on PubMed for relevant studies.
RESULTS: The search yielded a total of 93 studies from Medline and PubMed, of
which 23 studies were included in the final analysis. To date, there are various 
in vitro studies elucidating the potential mechanism of action of cannabinoids
for urological cancers, along with population-based studies specifically for
testicular malignancies. To date, no clinical trials have been conducted for
urological cancer patients.
CONCLUSIONS: These results demonstrate that the role of endocannabinoids for
urological malignancies is an area of active research. Further research is
required not only to evaluate the crosstalk between cancer signaling pathways and
cannabinoids, but also large randomized clinical studies with urological patients
need to be conducted before cannabinoids can be introduced as potential
therapeutic options for urological neoplasms.