Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: a scoping review

Some patients diagnosed with cancer use medical cannabis to self-manage undesirable symptoms, including nausea and pain. To improve patient safety and oncological care quality, the routes of administration for use of medical cannabis, patients’ reasons, and prescribed indications must be better understood.

Cannabinoids: Therapeutic Use in Clinical Practice

Medical case reports suggest that cannabinoids extracted from Cannabis sativa have ther- apeutic effects; however, the therapeutic employment is limited due to the psychotropic effect of its major component, ∆9-tetrahydrocannabinol (THC). The new scientific discoveries related to the endocannabinoid system, including new receptors, ligands, and mediators, allowed the development of new therapeutic targets for the treatment of several pathological disorders minimizing the undesir- able psychotropic effects of some constituents of this plant. Today, FDA-approved drugs, such as nabiximols (a mixture of THC and non-psychoactive cannabidiol (CBD)), are employed in alleviating pain and spasticity in multiple sclerosis. Dronabinol and nabilone are used for the treatment of chemotherapy-induced nausea and vomiting in cancer patients. Dronabinol was approved for the treatment of anorexia in patients with AIDS (acquired immune deficiency syndrome). In this review, we highlighted the potential therapeutic efficacy of natural and synthetic cannabinoids and their clinical relevance in cancer, neurodegenerative and dermatological diseases, and viral infections.

Cannabis Biomolecule Effects on Cancer Cells and Cancer Stem Cells: Cytotoxic, Anti-Proliferative, and Anti-Migratory Activities

Cancer is a complex family of diseases affecting millions of people worldwide. Gliomas are primary brain tumors that account for ~80% of all malignant brain tumors. Glioblastoma multiforme (GBM) is the most common, invasive, and lethal subtype of glioma. Therapy resistance and intra-GBM tumoral heterogeneity are promoted by subpopulations of glioma stem cells (GSCs). Cannabis sativa produces hundreds of secondary metabolites, such as flavonoids, terpenes, and phytocannabinoids. Around 160 phytocannabinoids have been identified in C. sativa. Cannabis is commonly used to treat various medical conditions, and it is used in the palliative care of cancer patients. The anti-cancer properties of cannabis compounds include cytotoxic, anti-proliferative, and anti-migratory activities on cancer cells and cancer stem cells. The endocannabinoids system is widely distributed in the body, and its dysregulation is associated with different diseases, including various types of cancer. Anti-cancer activities of phytocannabinoids are mediated in glioma cells, at least partially, by the endocannabinoid receptors, triggering various cellular signaling pathways, including the endoplasmic reticulum (ER) stress pathway. Specific combinations of multiple phytocannabinoids act synergistically against cancer cells and may trigger different anti-cancer signaling pathways. Yet, due to scarcity of clinical trials, there remains no solid basis for the anti-cancer therapeutic potential of cannabis compounds.

Cannabidiol (CBD) in Cancer Management

Cannabidiol (CBD) is one of the main constituents of the plant Cannabis sativa.
Surveys suggest that medicinal cannabis is popular amongst people diagnosed with cancer. CBD
is one of the key constituents of cannabis, and does not have the potentially intoxicating effects
that tetrahydrocannabinol (THC), the other key phytocannabinoid has. Research indicates the CBD
may have potential for the treatment of cancer, including the symptoms and signs associated with
cancer and its treatment. Preclinical research suggests CBD may address many of the pathways
involved in the pathogenesis of cancers. Preclinical and clinical research also suggests some evidence
of efficacy, alone or in some cases in conjunction with tetrahydrocannabinol (THC, the other key
phytocannabinoid in cannabis), in treating cancer-associated pain, anxiety and depression, sleep
problems, nausea and vomiting, and oral mucositis that are associated with cancer and/or its
treatment. Studies also suggest that CBD may enhance orthodox treatments with chemotherapeutic
agents and radiation therapy and protect against neural and organ damage. CBD shows promise as
part of an integrative approach to the management of cancer.

Cannabinoids in the landscape of cancer

Cannabinoids are a group of terpenophenolic compounds derived from the Cannabis sativa L. plant. There is a growing body of evidence from cell culture and animal studies in support of cannabinoids possessing anticancer properties.

A randomized trial of medical cannabis in patients with stage IV cancers to assess feasibility, dose requirements, impact on pain and opioid use, safety, and overall patient satisfaction

The prevalence of medical cannabis (MC) use in patients with cancer is growing, but questions about safety, efficacy, and dosing remain. Conducting randomized, controlled trials (RCTs) using state-sponsored MC programs is novel and could provide data needed to guide patients and providers.

Functional Fine-Tuning of Metabolic Pathways by the Endocannabinoid System—Implications for Health and Disease

The endocannabinoid system (ECS) employs a huge network of molecules (receptors, ligands, and enzymatic machinery molecules) whose interactions with other cellular networks have still not been fully elucidated. Endogenous cannabinoids are molecules with the primary function of control of multiple metabolic pathways. Maintenance of tissue and cellular homeostasis by functional fine-tuning of essential metabolic pathways is one of the key characteristics of the ECS. It is implicated in a variety of physiological and pathological states and an attractive pharmacological target yet to reach its full potential. This review will focus on the involvement of ECS in glucose and lipid metabolism, food intake regulation, immune homeostasis, respiratory health, inflammation, cancer and other physiological and pathological states will be substantiated using freely available data from open-access databases, experimental data and literature review.

Therapeutic potential of cannabinoids in combination cancer therapy

SCC member Kenzi Riboulet-Zemouli identifies a coherent nomenclature for cannabis products (whether derived from Cannabis sativa L. or not). The paper was published in Drug Science, Policy and Law in December of 2020.

A Comprehensive Review of Cannabis in Patients with Cancer: Availability in the USA, General Efficacy, and Safety

Dylan Zylla, MD and colleagues give an overview of cannabis treatments for cancer patients. They provide guidance to clinicians on how to have informed discussions regarding their care.

Oncology Clinicians and the Minnesota Medical Cannabis Program: A Survey on Medical Cannabis Practice Patterns, Barriers to Enrollment, and Educational Needs

Authors: Dylan Zylla, Grant Steele , Justin Eklund, Jeanne Mettner, Tom Arneson Published in Cannabis and cannabinoid research October 2018 Abstract Background:Medical cannabis has been available in the State of Minnesota since July 2015 through the Minnesota Medical Cannabis Program (MMCP). Objectives: Our study aimed to delineate oncology providers’ views on medical cannabis, identify barriers…