Oral cannabinoid for the prophylaxis of chemotherapy-induced nausea and vomiting—a systematic review and meta-analysis

Chow, Ronald; Valdez, Crystal E.; Chow, Natalie; Zhang, Dongke; Im, James; Sodhi, Emily U.; Lock, Michael

doi:10.1007/s00520-019-05280-4

Cited by 40 publications

(34 citation statements)

References 23 publications

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“…had excluded. 42 Their overall findings were consistent with the previous systematic reviews, reporting that oral cannabinoids are more effective than placebo (OR 3.45, 95% CI: 1.39 to 8.58)…”

Section: -16supporting

confidence: 90%

Framing the use of cannabis as a medicine in New Zealand: Regulatory, Clinician and Patient contexts

Oldfield¹

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A medicine is a substance developed for administration to humans for therapeutic purposes that achieves its action by pharmacological, immunological or metabolic means. Pharmaceutical medications undergo years of pre-clinical and clinical trials to establish their safety, tolerability and efficacy. Cannabis, whether in raw or processed form, sits predominantly outside this remit. Its use falls broadly into four categories; recreational, plant used for medicinal purposes, cannabis-based products marketed for medical purposes and pharmaceutical grade cannabinoid medications. The use of cannabis as a medicine involves complex interactions across social, health and political domains, at both a global and national level. New Zealand has attempted to address this with the implementation of the Medicinal Cannabis Scheme in April 2020. This research was undertaken to develop an understanding of what effect cannabis regulations have had on multiple jurisdictions enacting them and applying this to the New Zealand context, and to understand specific groups of patient-doctor interactions regarding the use of cannabis as a medicine. First, I undertook a meta-narrative qualitative review synthesising themes relating to the outcomes of cannabis regulatory change across multiple jurisdictions. Five super-ordinate themes were identified in the meta-narrative review; Normalisation, Gatekeeping, Economics, Community and Health, which were applied in framing the conclusion of this thesis. I then completed a systematic review / meta-analysis examining label accuracy and contaminants in cannabis-based products in regulated markets. Labelling accuracy ranged from 17 to ~86%. Contaminants included microbes, solvents, pesticides and adulterants. Meta-analysis of pesticide contamination showed that the overall proportion of contaminated samples was 0.25 (95% CI: 0.10 to 0.40, Heterogeneity: I2=79%, X12=4.74, p=0.03). Finally, I completed six observational studies within New Zealand to determine knowledge, beliefs and reported interactions of doctors and patients regarding the use of cannabis as a medicine in three medical disciplines; general practice (GP), oncology and neurology. Doctors reported that patients were requesting medical cannabis prescriptions (GP: 55%, Neurology: 63%. Oncology: 84% respectively), and informing them of using illicit cannabis for medical symptoms. All doctors were concerned about prescribing cannabis as a medicine due to lack of evidence and lack of understanding of the prescription processes. Despite this, the majority were willing to prescribe a funded cannabis-based product backed by evidence of efficacy in traditional clinical trials. Patients in all three disciplines indicated comfort discussing cannabis with GPs and specialists (GP patients: 91.7%, 92.1%, neurology patients: 88.2%, 90.6%, oncology patients: 85.8%, 88.2% respectively). All groups reported low levels of prescriptions received (<20%). Patients reported illicit use of cannabis for medical reasons (11.2%, 34.6% and 35.5% in GP, neurology and oncology patients respectively), with reported effectiveness of illicit cannabis for their condition ranging from 86.7 to 94.0%. Patients in all three fields wished to know the benefits, side effects and availability of cannabis-based products and had concerns regarding access and cost. The use of cannabis as a medicine remains a complex situation within the NZ context. Significant implementation issues remain for the Medicinal Cannabis Scheme to ensure the safety and wellbeing of patients in New Zealand.

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Section: -16supporting

confidence: 90%

Framing the use of cannabis as a medicine in New Zealand: Regulatory, Clinician and Patient contexts

Oldfield¹

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“…Therefore, the pharmaceutical modulation of ES, e.g., by administration of plant or synthetic cannabinoids, has become a promising therapeutic strategy in treating acquired immunodeficiency (AIDS)-associated weight loss or spasticity in MS and supporting palliative care (e.g., standardized plant extract nabiximols/Sativex ® or synthetic nabilone/Cesamet ® and dronabinol/Marinol ® ). Some amount of evidence show that oral cannabinoids may have a role in controlling chemotherapy-induced nausea and vomiting (CINV) but more studies have to be done to confirm this effect [35].…”

Section: Cannabinoids In Medicinementioning

confidence: 99%

Cannabinoids in Medicine: Cancer, Immunity, and Microbial Diseases

Śledziński

Nowak-Terpiłowska

Zeyland

2020

IJMS

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Recently, there has been a growing interest in the medical applications of Cannabis plants. They owe their unique properties to a group of secondary metabolites known as phytocannabinoids, which are specific for this genus. Phytocannabinoids, and cannabinoids generally, can interact with cannabinoid receptors being part of the endocannabinoid system present in animals. Over the years a growing body of scientific evidence has been gathered, suggesting that these compounds have therapeutic potential. In this article, we review the classification of cannabinoids, the molecular mechanisms of their interaction with animal cells as well as their potential application in the treatment of human diseases. Specifically, we focus on the research concerning the anticancer potential of cannabinoids in preclinical studies, their possible use in cancer treatment and palliative medicine, as well as their influence on the immune system. We also discuss their potential as therapeutic agents in infectious, autoimmune, and gastrointestinal inflammatory diseases. We postulate that the currently ongoing and future clinical trials should be accompanied by research focused on the cellular and molecular response to cannabinoids and Cannabis extracts, which will ultimately allow us to fully understand the mechanism, potency, and safety profile of cannabinoids as single agents and as complementary drugs.

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“…CINV is classified according to its time of incidence as either acute (0-24 h post-chemotherapy) or delayed (24-120 h post-chemotherapy). CINV that occurs during the course of chemotherapy despite a prophylactic regimen is termed as breakthrough CINV [6,7].…”

Section: Introductionmentioning

confidence: 99%

Olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting: a systematic review, meta-analysis, cumulative meta-analysis and fragility assessment of the literature

Chow

Herrstedt

Aapro

et al. 2021

Support Care Cancer

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Introduction The aim of this study is to rigorously review the efficacy and safety of olanzapine in defined hematology oncology settings including (1) the setting of highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) settings (2) at 5 mg and 10 mg doses, and (3) for response rates for use in the acute, delayed, and overall settings post-MEC and HEC. Methods Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched through April 23, 2020. The primary efficacy endpoints were the rate of complete response, in the acute (0-24 h post-chemotherapy), delayed (24-120 h post-chemotherapy), and overall (0-120 h post-chemotherapy) phases. The secondary efficacy endpoints were the rates of no nausea and no emesis, for each phase. Safety endpoints were the rate of no serious adverse events (i.e., no grade 3 or 4 toxicities), as assessed by Common Terminology Criteria for Adverse Events (CTCAE) criteria. The Mantel-Haenszel, random-effects analysis model was used to compute risk ratios and accompanying 95% confidence intervals for each endpoint. For endpoints that statistically favored one arm, absolute risk differences were computed to assess whether there is a 10% or greater difference, used as the threshold for clinical significance by MASCC/ESMO. Fragility indices were also calculated for each statistically significant endpoint, to quantitatively assess the robustness of the summary estimate. A cumulative meta-analysis was conducted for each efficacy meta-analysis with more than 5 studies, also using the Mantel-Haenszel random-effects analysis model. Results Three studies reported on olanzapine for the rescue of breakthrough chemotherapy-induced nausea and vomiting (CINV); 22 studies reported on olanzapine in the prophylactic setting. For studies reporting on HEC patients, olanzapinecontaining regimens were statistically and clinically superior in seven of nine efficacy endpoints in the prophylaxis setting. When olanzapine is administered at a 10-mg dose, it is statistically and clinically superior to control patients in eight of nine endpoints among adults. Olanzapine may be effective in the MEC setting and when administered at 5-mg doses, but the paucity of data leads to notable uncertainty. Conclusion Further RCTs are needed in the setting of MEC patients and administration of olanzapine at a lower 5-mg dose, which may be given to reduce the sedative effect of olanzapine at 10 mg.

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Oral cannabinoid for the prophylaxis of chemotherapy-induced nausea and vomiting—a systematic review and meta-analysis

Cited by 40 publications

References 23 publications

Framing the use of cannabis as a medicine in New Zealand: Regulatory, Clinician and Patient contexts

Framing the use of cannabis as a medicine in New Zealand: Regulatory, Clinician and Patient contexts

Cannabinoids in Medicine: Cancer, Immunity, and Microbial Diseases

Olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting: a systematic review, meta-analysis, cumulative meta-analysis and fragility assessment of the literature

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