Safety and efficacy of nabilone for acute chemotherapy‐induced vomiting prophylaxis in pediatric patients: A multicenter, retrospective review

Polito, Samantha; MacDonald, Tamara; Romanick, Marcel; Jupp, Jennifer; Wiernikowski, Jennifer; Vennettilli, Ashlee; Khanna, Mila; Patel, Priya; Ning, Winnie; Sung, Lillian; Dupuis, L. Lee

doi:10.1002/pbc.27374

Cited by 28 publications

(17 citation statements)

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“…1: Laredo and Pondra diapirs (López-Horgue et al, 2010); 2: Poza de la Sal diapir (Quintà et al, 2012); 3: Bakio diapir (Poprawski et al, 2014(Poprawski et al, , 2016; 4: Lasarte sub-basin salt controlled basin (Bodego & Agirrezabala, 2013;Bodego, Iriarte, López-Horgue, & Álvarez, 2018); 5-7: Gaujacq and Ossun diapirs (Canérot et al, 2005); 6: Mauléon basin diapirs (Jammes et al, 2010); 8: Cotiella extensional salt area (McClay et al, 2004); 9: Sopeira and Sant Gervàs diapirs (Saura et al, 2016); 10: Villahermosa del Rio diapir (Canérot, 1991); 11: Parcent diapir (Pedrera et al, 2014); 12: Altea diapir (Pedrera et al, 2014;Martínez del Olmo et al, 2015); 13, 14: Finestrat and Elda diapirs (Martínez del Olmo et al, 2015); 15: Jumilla diapirs (Escosa et al, 2018); 16: Western Betics ; 17, 18: Faro and Albuferia diapirs (Ramos et al, 2016); 19, 20: Santa Cruz and Caldas da Rainha diapirs (Alves et al, 2003;Pena do Reis et al, 2017). Iberian Range AB: Aragoneses Branch; Iberian Range CB: Castillan Branch; PB: Parentis Basin; AB: Asturian Basin; AP: As Pontes Basin; ALZ: Asturoccidental-Leonese Zone; CZ: Cantabric Zone; CM: Cantabrian Mountain; CS: Central System; CCR: Catalan Coastal Range; GB: Guadalquivir Basin unconformities within the Jurassic and Lower Cretaceous successions were traditionally interpreted in terms of syn-rift to post-rift differential subsidence between fault-bounded tectonic domains (Aurell et al, 1992;Campos, Aurell, & Casas, 1996;Guimerà, 1988;Liesa, Soria, Meléndez, & Meléndez, 2006;Roca & Guimerà, 1992;Roca, Guimerà, & Salas, 1994;. The only previously documented examples of halokinesis within the Maestrat Basin are a diapir located in the Penyagolosa block near Villahermosa del Río village and in Lucena del Cid, north of Castelló (Canérot, 1989(Canérot, , 1991Trell, Canérot, & Martín, 1979) (see location in…”

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Tectono‐sedimentary evolution of Jurassic–Cretaceous diapiric structures: Miravete anticline, Maestrat Basin, Spain

et al. 2020

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confidence: 99%

Tectono‐sedimentary evolution of Jurassic–Cretaceous diapiric structures: Miravete anticline, Maestrat Basin, Spain

et al. 2020

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“…45 Polito et al undertook a retrospective review in 2018 of 110 paediatric patients using nabilone for CINV, primarily in conjunction with standard anti-emetic therapy (5HT3) for acute CINV. 46 They found that the proportion of patients obtaining a complete response to combined therapy was low (50.6% in moderate emetogenic chemotherapy and 53.8% in high emetogenic chemotherapy) and similar to previously described mono-therapy. 46 There has been interest in the use of cannabinoid-based medicines in other areas of nausea relief, specifically in the areas of radiotherapy and post-operative care.…”

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confidence: 84%

“…46 They found that the proportion of patients obtaining a complete response to combined therapy was low (50.6% in moderate emetogenic chemotherapy and 53.8% in high emetogenic chemotherapy) and similar to previously described mono-therapy. 46 There has been interest in the use of cannabinoid-based medicines in other areas of nausea relief, specifically in the areas of radiotherapy and post-operative care. Kleine-Brueggeney et al…”

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confidence: 84%

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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“…76 Currently, cannabinoids (nabilone, dronabinol) are considered as third or fourth line of choice, or as the last option in patients in which previous standard treatments do not achieve the desired effect. 31,37,43,47,[82][83][84][85] Unfortunately, a ratio of the effectiveness of cannabinoid compared to the effectiveness of conventional therapy is still unknown. Chronic use of cannabinoids can cause an excessive hyperemesis syndrome characterized by cyclic vomiting without any other recognizable reasons.…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapeutic Considerations for Use of Cannabinoids to Relieve Symptoms of Nausea and Vomiting Induced by Chemotherapy

Serafimovska¹,

Darkovska-Serafimovska²,

Stefkov³

et al. 2020

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Patients suffering from malignant diseases receive very often highly emetogenic chemotherapy as part of their treatment. With the aim of assessing the efficacy of cannabinoids in treating chemotherapy-induced nausea and vomiting (CINV), we searched the literature published until April 2020 in Medline/PubMed, Embase, the Cochrane Controlled Trials Register, and in specific web pages. Randomized clinical trials comparing cannabinoids efficacy in managing CINV with that of placebo reported absence of vomit-ing (3 trials, 168 patients) and absence of nausea and vomiting (3 trials, 288 participants). In comparison with patients receiving other antiemetics, patients receiving cannabinoids reported no nausea (5 trials, 258 participants), no vomiting (4 trials, 209 participants), and absence of both (4 trials, 414 patients). Across all trials, cannabinoids were more effective in relieving the symptoms of nausea and vomiting induced by cytotoxic therapy than placebo was and slightly better than conventional antiemetics. A retrospective review com-paring nabilone, dronabinol, delta-9-THC, and delta 8-THC with other antiemetics used to manage CINV in pediatric patients showed that these drugs could also be used as adjuvant antiemetics. Cancer patients on highly emetogenic chemotherapy but with insufficiently effective standard antiemetic therapy can be given cannabis preparations containing similar amounts of tetrahydrocannabinol and can-nabidiol, which should be received in strict compliance with the professional guidelines for the treatment of CINV. 

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Safety and efficacy of nabilone for acute chemotherapy‐induced vomiting prophylaxis in pediatric patients: A multicenter, retrospective review

Abstract: Adverse events associated with nabilone were common but of minor clinical significance. Acute CIV control in children receiving nabilone as a part of their antiemetic regimen was poor. Future work should focus on implementation of guideline-consistent CINV prophylaxis and treatment.

Cited by 28 publications

References 16 publications

Tectono‐sedimentary evolution of Jurassic–Cretaceous diapiric structures: Miravete anticline, Maestrat Basin, Spain

Tectono‐sedimentary evolution of Jurassic–Cretaceous diapiric structures: Miravete anticline, Maestrat Basin, Spain

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

Pharmacotherapeutic Considerations for Use of Cannabinoids to Relieve Symptoms of Nausea and Vomiting Induced by Chemotherapy

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