Medical Cannabis Certification in a Large Pediatric Oncology Center

Skrypek, Mary; Bostrom, Bruce; Bendel, Anne

doi:10.3390/children6060079

Cited by 8 publications

(13 citation statements)

References 10 publications

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“…With the increasing availability of medicinal cannabis, there is a growing demand from patients, parents, and physicians for better information describing the safety and efficacy of cannabinoids in pediatric brain tumors [ 30 , 31 , 32 ], although reports describing the proportion of pediatric oncology patients actively seeking or using medical cannabis are scarce. A recent report from the Children’s Hospital of Minnesota stated that hope for an anti-tumor effect was the major reason parents sought medical cannabis for children with brain cancer despite a lack of evidence demonstrating such an effect [ 32 ]. To address these gaps in the literature and to help identify novel anti-cancer agents with better safety profiles for the treatment of these diseases, our study aimed to investigate the anti-cancer efficacy and mechanisms of action for THC and CBD in preclinical models of pediatric medulloblastoma and ependymoma.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Cannabidiol and Δ9-Tetrahydrocannabiol in Mouse Models of Medulloblastoma and Ependymoma

Andradas

Byrne

Kuchibhotla

et al. 2021

Cancers

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Children with medulloblastoma and ependymoma are treated with a multidisciplinary approach that incorporates surgery, radiotherapy, and chemotherapy; however, overall survival rates for patients with high-risk disease remain unsatisfactory. Data indicate that plant-derived cannabinoids are effective against adult glioblastoma; however, preclinical evidence supporting their use in pediatric brain cancers is lacking. Here we investigated the potential role for Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in medulloblastoma and ependymoma. Dose-dependent cytotoxicity of medulloblastoma and ependymoma cells was induced by THC and CBD in vitro, and a synergistic reduction in viability was observed when both drugs were combined. Mechanistically, cannabinoids induced cell cycle arrest, in part by the production of reactive oxygen species, autophagy, and apoptosis; however, this did not translate to increased survival in orthotopic transplant models despite being well tolerated. We also tested the combination of cannabinoids with the medulloblastoma drug cyclophosphamide, and despite some in vitro synergism, no survival advantage was observed in vivo. Consequently, clinical benefit from the use of cannabinoids in the treatment of high-grade medulloblastoma and ependymoma is expected to be limited. This study emphasizes the importance of preclinical models in validating therapeutic agent efficacy prior to clinical trials, ensuring that enrolled patients are afforded the most promising therapies available.

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Section: Introductionmentioning

confidence: 99%

Assessment of Cannabidiol and Δ9-Tetrahydrocannabiol in Mouse Models of Medulloblastoma and Ependymoma

Andradas

Byrne

Kuchibhotla

et al. 2021

Cancers

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“…The infants suffer from cognitive decline, motor, and behavioral abnormalities 3 , 4 . Other presentations of epilepsy and additional indications, such as autism, and inflammatory bowel disease (IBD) have been reported recently 5 – 7 The non-psychoactive substance cannabidiol (CBD) is used for these indications, whereas chemotherapy-induced nausea and vomiting (CINV) are treated with the psychoactive D-9-Tetrahydrocannabinol (THC) and its analogues 8 – 10 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of medical cannabinoids in children: a systematic review and meta-analysis

Treves

Mor

Allegaert

et al. 2021

Sci Rep

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Despite the increased use of medical cannabinoids, the efficacy and safety of the treatment among children remain uncertain. The objective was to study the efficacy and safety of medical cannabinoids in children. The search included studies through 11-May-2020. Selection criteria included studies evaluating efficacy and safety outcomes of medical cannabinoids (tetrahydrocannabinol, cannabidiol and other cannabis derivatives) versus control in children, independently assessed by two reviewers. Eight studies were included, all of which are randomized controlled trials. Cannabidiol is associated with 50% reduction in seizures rate (Relative Risk (RR) = 1.69, 95% CI [1.20–2.36]) and caregiver global impression of change (Median Estimated difference = (− 1), 95%CI [− 1.39–(− 0.60)]) in Dravet syndrome, compared to placebo. While cannabidiol was associated with a reduction in reported seizure events (RR = 0.59, 95% CI [0.36–0.97]), no association was found in products contained also tetrahydrocannabinol (RR = 1.35, 95% CI [0.46–4.03]). Higher dose of cannabidiol was associated with decreased appetite (RR = 2.40, 95% CI [1.39–4.15]). A qualitative assessment suggests that medical cannabinoids might be associated with adverse mental events. In conclusion, cannabidiol is associated with clinical improvement in Dravet syndrome. However, cannabidiol is also associated with decreased appetite. Adverse mental events were reported as well, however, more research should be performed to assess well this outcome.

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“…These studies did not include children with brain cancer. A more recent report describing the experience of patients at Children’s Minnesota, which did include children with brain cancer, states that cannabinoid use in conjunction with traditional antiemetic regimens does improve the patient chemotherapy experience and quality of life [ 69 ].…”

Section: Role For Cannabinoids To Improve Quality Of Life For Pedimentioning

confidence: 99%

The Role of Cannabinoids as Anticancer Agents in Pediatric Oncology

Andradas

Truong

Byrne

et al. 2021

Cancers

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Cannabinoids are a group of chemicals that bind to receptors in the human body and, in turn, modulate the endocannabinoid system (ECS). They can be endogenously produced, synthetic, or derived from the plant Cannabis sativa L. Research over the past several decades has shown that the ECS is a cellular communication network essential to maintain multiple biological functions and the homeostasis of the body. Indeed, cannabinoids have been shown to influence a wide variety of biological effects, including memory, pain, reproduction, bone remodeling or immunity, to name a few. Unsurprisingly, given these broad physiological effects, alterations of the ECS have been found in different diseases, including cancer. In recent years, the medical use of cannabis has been approved in different countries for a variety of human conditions. However, the use of these compounds, specifically as anticancer agents, remains controversial. Studies have shown that cannabinoids do have anticancer activity in different tumor types such as breast cancer, melanoma, lymphoma and adult brain cancer. Specifically, phytocannabinoids Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) has been shown to induce apoptosis and inhibit proliferation of adult cancer cells, as well as modulate angiogenesis and metastasis. Despite increasing evidence that cannabinoids elicit antitumor effects in adult cancers, there is minimal data available on their effects in children or in pediatric cancers despite public and clinical demand for information. Here we describe a comprehensive and critical review of what is known about the effects of cannabinoids on pediatric cancers, highlight current gaps in knowledge and identify the critical issues that need addressing before considering these promising but controversial drugs for use in pediatric oncology.

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Medical Cannabis Certification in a Large Pediatric Oncology Center

Cited by 8 publications

References 10 publications

Assessment of Cannabidiol and Δ9-Tetrahydrocannabiol in Mouse Models of Medulloblastoma and Ependymoma

Assessment of Cannabidiol and Δ9-Tetrahydrocannabiol in Mouse Models of Medulloblastoma and Ependymoma

Efficacy and safety of medical cannabinoids in children: a systematic review and meta-analysis

The Role of Cannabinoids as Anticancer Agents in Pediatric Oncology

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