Should oncologists trust cannabinoids?

Abstract

Cannabis enjoyed a “golden age” as a medicinal product in the late 19th, early 20th century, but the increased risk of overdose and abuse led to its criminalization. However, the 21st century have witnessed a resurgence of interest and a large body of literature regarding the benefits of cannabinoids have emerged. As legalization and decriminalization have spread around the world, cancer patients are increasingly interested in the potential utility of cannabinoids. Although eager to discuss cannabis use with their oncologist, patients often find them to be reluctant, mainly because clinicians are still not convinced by the existing evidence-based data to guide their treatment plans. Physicians should prescribe cannabis only if a careful explanation can be provided and follow up response evaluation ensured, making it mandatory for them to be up to date with the positive and also negative aspects of the cannabis in the case of cancer patients. Consequently, this article aims to bring some clarifications to clinicians regarding the sometimes-confusing various nomenclature under which this plant is mentioned, current legislation and the existing evidence (both preclinical and clinical) for the utility of cannabinoids in cancer patients, for either palliation of the associated symptoms or even the potential antitumor effects that cannabinoids may have.

Immunotherapy and Cannabis: A Harmful Drug Interaction or Reefer Madness?

“…Creanga-Murariu et al [6] Frontiers in Pharmacology When the values in a fourfold table are fairly small a "correction for continuity" know as the "Yates' correction" may be applied. Although there is no precise rule defining circumstances in which to use Yates' correction, a common practice is to incorporate into χ² calculations on tables with a total of under 100 or with any cell containing a va less than 10."…”

“…Checkpoint inhibition therapy is a form of cancer immunotherapy that employs antibodies against T cell or antigen presenting cell surface regulators of immune cell inhibition, (i.e., checkpoint inhibitors), to then activate cytotoxic T cells to assist in the killing of tumor cells [5]. Two major immune checkpoint pathways that are currently targeted in oncologic immunotherapeutics are the cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) which regulate T-cell proliferation primarily in lymph nodes early in an immune response, and the programmed cell death protein (PD-1) pathways which suppresses T cells in peripheral tissues later the immune response [5, 6]. Inhibition of these targets, resulting in increased activation of the immune system, has led to new immunotherapies for melanoma, non–small cell lung cancer, and several other cancers [6].…”

“…Two major immune checkpoint pathways that are currently targeted in oncologic immunotherapeutics are the cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) which regulate T-cell proliferation primarily in lymph nodes early in an immune response, and the programmed cell death protein (PD-1) pathways which suppresses T cells in peripheral tissues later the immune response [5, 6]. Inhibition of these targets, resulting in increased activation of the immune system, has led to new immunotherapies for melanoma, non–small cell lung cancer, and several other cancers [6]. Ipilimumab, an inhibitor of CTLA-4, is approved for the treatment of advanced or unresectable melanoma [3, 7].…”

Recent Advances in Neuroblastoma Research

“…Two reports in this issue, by Wang et al and Ahmed et al [9,10], describe the effects of natural compounds, cannabinoids deriving from Cannabis Sativa L. and marine cyanobacterial peptides, respectively, on neuroblastoma growth. Cannabinoids have demonstrated anticancer effects in preclinical in vitro and in vivo models, and several clinical trials on different synthetic or natural cannabinoids are ongoing for adult cancers [11]. However, there are also reports that cannabinoids have enhancing effects on the growth of cancer cells [11].…”

“…Cannabinoids have demonstrated anticancer effects in preclinical in vitro and in vivo models, and several clinical trials on different synthetic or natural cannabinoids are ongoing for adult cancers [11]. However, there are also reports that cannabinoids have enhancing effects on the growth of cancer cells [11]. Wang et al show that the phytocannabinoid cannabinol attenuates cell proliferation, angiogenesis and invasion by inhibiting the activity of PI3K/AKT signaling and upregulating miR-34a, which directly silences E2F1 and guides the production of rRiMetF31, which targets 6-phosphofructo-2-kinase/fructos-2,6-biphosphate-3 (PFKFB3) in neuroblastoma cells [9].…”