Cannabinoid and Cancer / ABRIL 2018

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Cannabinoids and Cancer

1.
Pharmacotherapeutic considerations for use of cannabinoids to relieve pain in
patients with malignant diseases.

Darkovska-Serafimovska M(1), Serafimovska T(2), Arsova-Sarafinovska Z(1),
Stefanoski S(3), Keskovski Z(3), Balkanov T(4).

Author information: 
(1)Department of Pharmacology, Faculty of Medical Sciences, Goce Delcev
University, Stip, Republic of Macedonia.
(2)Faculty of Pharmacy, Ss Cyril and Methodius University of Skopje, Skopje,
Republic of Macedonia.
(3)NYSK Holdings, Skopje, Republic of Macedonia.
(4)Department of Pharmacology and Toxicology, Faculty of Medicine, Ss Cyril and
Methodius University of Skopje, Skopje, Republic of Macedonia.

Purpose: The aim of this review was to assess the efficacy of cannabis
preparations for relieving pain in patients with malignant diseases, through a
systematic review of randomized controlled trials (RCTs), which were
predominantly double-blind trials that compared cannabis preparation to a
placebo.
Methods: An electronic search of all literature published until June 2017 was
made in MEDLINE/PubMed, Embase, The Cochrane Controlled Trials Register and
specific web pages devoted to cannabis.
Results: Fifteen of the 18 trials demonstrated a significant analgesic effect of 
cannabinoids as compared to placebo. The most commonly reported adverse effects
were generally well tolerated, mild to moderate. The main side effects were
drowsiness, nausea, vomiting and dry mouth. There is evidence that cannabinoids
are safe and modestly effective in neuropathic pain and also for relieving pain
in patients with malignant diseases. The proportion of "responders" (patients who
at the end of 2 weeks of treatment reported ≥30% reduction in pain intensity on a
scale of 0-10, which is considered to be clinically important) was 43% in
comparison with placebo (21%).
Conclusion: The target dose for relieving pain in patients with malignant
diseases is most likely about 10 actuations per day, which is about 27 mg
tetrahydrocannabinol (THC) and 25 mg cannabidiol (CBD), and the highest approved 
recommended dose is 12 actuations per day (32 mg THC/30 mg CBD). Further large
studies of cannabinoids in homogeneous populations are required.



2.
INSIGHT ON THE IMPACT OF ENDOCANNABINOID SYSTEM IN CANCER: A REVIEW.

Fraguas-Sánchez AI(1), Martín-Sabroso C(1), Torres-Suárez AI(1)(2).

Author information: 
(1)Department of Pharmaceutical Technology, Faculty of Pharmacy, Complutense
University of Madrid, 28040, Madrid, Spain.
(2)Institute of Industrial Pharmacy, Complutense University of Madrid, 28040,
Madrid, Spain.

In the last decades, the endocannabinoid system has attracted a great interest in
medicine and cancer disease is probably one of its most promising therapeutic
areas. On the one hand, endocannabinoid system expression has been found altered 
in numerous types of tumours compared to healthy tissue, and this aberrant
expression has been related to cancer prognosis and disease outcome, suggesting a
role of this system in tumour growth and progression that depends on cancer type.
On the other hand, it has been reported that cannabinoids exert an anticancer
activity by inhibiting the proliferation, migration and/or invasion of cancer
cells; and also tumour angiogenesis. However, some cannabinoids, at lower
concentrations, may increase tumour proliferation, inducing cancer growth. The
endocannabinoid system may be considered as a new therapeutic target, although
further studies to fully establish the effect of cannabinoids on tumour
progression remain necessary.

This article is protected by copyright. All rights reserved.


3.
[Cannabinoid therapy in practice].

[Article in German]

Rasche T(1), Emmert D(1), Stieber C(1), Mücke M(2)(3)(4), Conrad R(5).

Author information: 
(1)Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Bonn,
Deutschland.
(2)Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Bonn,
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(3)Institut für Hausarztmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
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(4)Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
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(5)Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie,
Universitätsklinikum Bonn, Bonn, Deutschland.

BACKGROUND: In recent years, the media and scientists have shown increased
interest in cannabis-based drugs.
OBJECTIVES: Background information about cannabis-based drugs and their mechanism
of action as well as discussion of possible applications as supportive therapy or
in palliative medicine, respectively, are presented.
MATERIALS AND METHODS: The recent literature was examined and evaluated.
RESULTS: In many medical fields, we do not have sufficient evidence for the
efficacy of cannabinoids. In German pharmaceutical legislation, the use of
nabiximols for the treatment of intermediate to severe, therapy-resistant
spasticity in multiple sclerosis is the only approved indication for
cannabis-based drugs. Furthermore, in view of the current evidence cannabinoids, 
combined with established treatments and as part of an individual therapeutic
attempt, can be used for neuropathic pain, cancer-associated pain and human
immunodeficiency virus (HIV)-related cachexia.
CONCLUSIONS: In most cases, today's assessment of cannabinoids relies on studies 
that are classified as low evidence. Therefore, further studies which involve
more participants and evaluate long-term effects are needed.


4.
Do the potential benefits outweigh the risks? An update on the use of ziconotide 
in clinical practice.

Bäckryd E(1).

Author information: 
(1)Pain and Rehabilitation Centre, Department of Medical and Health Sciences,
Linköping University, Linköping, Sweden.

Ziconotide is a selective and potent blocker of N-type voltage-gated calcium
channels. It was approved by the Food and Drug Administration in 2004 and by the 
European Medicines Agency in 2005 for the treatment of severe chronic pain in
patients needing intrathecal analgesia (ITA). The aim of this paper is to provide
a practitioner-oriented, educational, narrative, up-to-date review on the use of 
ziconotide in clinical pain medicine. Of special concern regarding safety is the 
partial incongruity between dosing statements in the Summary of Product
Characteristics and novel low-dosage, slow uptitration recommendations. Even
though ziconotide has obvious advantages compared to opioids, pain practitioners 
pondering the use of ziconotide nonetheless have to balance its proved potential 
analgesic effect against its neurological side effects, with special
consideration being given to dosing and neuropsychiatric dangers. Using a seesaw 
analogy, the paper discusses what factors pain physicians should weigh in when
considering ziconotide as ITA drug, the non-opioid advantages of ziconotide being
counterbalanced by its potential psychiatric side effects. Ziconotide is an
important part of the armamentarium of modern interventional pain medicine. If
ITA is deemed necessary, ziconotide is a rational alternative, at least in
chronic (neuropathic) non-cancer pain. However, in many European countries,
ziconotide treatment is only available in a few (if any) centres. The safety
profile of ziconotide is not fundamentally more worrying than that of opioids or 
cannabinoids; it is just different. This paper provides a concise, up-to-date and
clinically-oriented summary of the use of ziconotide in clinical practice, not
least concerning safety and dosage issues.

© 2018 European Pain Federation - EFIC®.


5.
Current status and future therapeutic perspectives of glioblastoma multiforme
(GBM) therapy: A review.

Anjum K(1), Shagufta BI(2), Abbas SQ(3), Patel S(4), Khan I(1), Shah SAA(1),
Akhter N(1), Hassan SSU(5).

Author information: 
(1)Ocean College, Zhejiang University, Hangzhou, 310058, China.
(2)Department of Zoology, Kohat University of Science and Technology (KUST),
K.P.K 26000, Pakistan.
(3)Faculty of Pharmacy, Gomal University D.I.Khan, K.P.K 29050, Pakistan.
(4)Bioinformatics and Medical Informatics Research Center, San Diego State
University, San Diego-92182, USA.
(5)College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058,
China. Electronic address: Esta dirección de correo electrónico está siendo protegida contra los robots de spam. Necesita tener JavaScript habilitado para poder verlo..

Erratum in
    Biomed Pharmacother. 2018 Mar 8;101:820.

Glioblastoma multiforme (GBM) is the deadliest form of heterogeneous brain
cancer. It affects an enormous number of patients every year and the survival is 
approximately 8 to 15 months. GBM has driven by complex signaling pathways and
considered as a most challenging to treat. Standard treatment of GBM includes
surgery, radiation therapy, chemotherapy and also the combined treatment. This
review article described inter and intra- tumor heterogeneity of GMB. In
addition, recent chemotherapeutic agents, with their mechanism of action have
been defined. FDA-approved drugs also been focused over here and most importantly
highlighting some natural and synthetic and novel anti- glioma agents, that are
the main focus of researchers nowadays.

Copyright © 2017 Elsevier Masson SAS. All rights reserved.