The heterogeneity and complexity of <i>Cannabis</i> extracts as antitumor agents

Baram, Liran; Peled, Ella; Berman, Paula; Yellin, Ben; Besser, Elazar; Benami, Maya; Louria-Hayon, Igal; Lewitus, Gil M.; Meiri, David

doi:10.18632/oncotarget.26983

Cited by 83 publications

(92 citation statements)

References 51 publications

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“…they find therapeutic and comforting for both the conditions they are approved for and for other nonindicated comorbidities, such as ADHD. The complexity created with whole-plant products that include over 144 phyto-cannabinoids 33 and scores of terpenoids 35 eludes simplistic conclusions about the effect of MC on the management of ADHD symptomatology. 22 Noteworthily, in the case report of Strohbeck-Kuehner et al, 22 it was suggested that cannabis treatment and synthetic THC administered to a 28-year-old man with ADHD resulted in a marked change in ADHD symptomatology without investigation of other cannabis constituents.…”

Section: Discussionmentioning

confidence: 99%

“…Phyto-cannabinoid analyses were performed using a Thermo Scientific ultra-high-performance liquid chromatography (UHPLC) system coupled with a Q Exactive™ Focus Hybrid QuadrupoleOrbitrap mass spectrometer (MS) (Thermo Scientific, Bremen, Germany). 33 Identification and absolute quantification of phyto-cannabinoids were performed by external calibrations. 34…”

Section: Phyto-cannabinoid Identification and Quantification By Lc-msmentioning

confidence: 99%

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Cannabinoid and Terpenoid Doses are Associated with Adult ADHD Status of Medical Cannabis Patients

Hergenrather¹,

Aviram²,

Vysotski³

et al. 2020

Rambam Maimonides Med J

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Objective: The aim of this cross-sectional questionnaire-based study was to identify associations between the doses of cannabinoids and terpenes administered, and symptoms of attention deficit hyperactivity disorder (ADHD). Medical Cannabis Treatment and ADHDRambam Maimonides Medical Journal 2 January 2020  Volume 11  Issue 1  e0001 Methods: Participants were adult patients licensed for medical cannabis (MC) treatment who also reported a diagnosis of ADHD by a physician. Data on demographics, ADHD, sleep, and anxiety were collected using self-report questionnaires. Data collected on MC treatment included administration route, cultivator, cultivar name, and monthly dose. Comparison statistics were used to evaluate differences in reported parameters between low (20-30 g, n=18) and high (40-70 g, n=35) MC monthly dose and low adult ADHD self-report scale (ASRS, 0-5) score (i.e. ≤3.17 score, n=30) or high ASRS score (i.e. ≥3.18 score, n=29) subgroups. Results:From the 59 patients that answered the questionnaire, MC chemovar could be calculated for 27 (45%) of them. The high MC monthly dose group consumed higher levels of most phyto-cannabinoids and terpenes, but that was not the case for all of the cannabis components. The high dose consumers and the ones with lower ASRS score reported a higher occurrence of stopping all ADHD medications. Moreover, there was an association between lower ASRS score subgroup and lower anxiety scores. In addition, we found an association between lower ASRS score and consumption of high doses of cannabinol (CBN), but not with ∆-9-tetrahydrocannabinol (THC). Conclusion:These findings reveal that the higher-dose consumption of MC components (phytocannabinoids and terpenes) is associated with ADHD medication reduction. In addition, high dosage of CBN was associated with a lower ASRS score. However, more studies are needed in order to fully understand if cannabis and its constituents can be used for management of ADHD.

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Section: Discussionmentioning

confidence: 99%

Section: Phyto-cannabinoid Identification and Quantification By Lc-msmentioning

confidence: 99%

Cannabinoid and Terpenoid Doses are Associated with Adult ADHD Status of Medical Cannabis Patients

Hergenrather¹,

Aviram²,

Vysotski³

et al. 2020

Rambam Maimonides Med J

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“…Cancer itself is a qualifying condition for medical cannabis, opening the door to treating not only cancer‐associated pain and symptoms, but also cancer itself. Although there is a body of in vivo and in vitro laboratory evidence to suggest possible mechanisms for the antitumor properties of cannabis such as the induction of apoptosis and prevention of tumor cell proliferation, to our knowledge these findings have not been translated into humans . We assert that endorsement of the use of medical cannabis for its purported antineoplastic properties or in lieu of US Food and Drug Administration (FDA)–approved cancer treatments is potentially dangerous.…”

Section: Cannabis: Indications Use Versus Evidence Basementioning

confidence: 97%

Medical cannabis use among individuals with cancer: An unresolved and timely issue

Nugent

Meghani

Rogal

et al. 2020

Cancer

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The role of cannabis in cancer care is a complex and challenging issue. Cancer and its treatments currently are designated as qualifying conditions in the majority of the 33 states that now have legalized medical cannabis. 1 Consequently, cannabis use in patients with cancer is common: nearly one-quarter of individuals with cancer report current cannabis use 2,3 and >90% of cancer survivors view cannabis as potentially beneficial for symptom management and support its legalization. 4 Recent studies have suggested that physicians may be more likely to recommend cannabis to patients with cancer compared with patients with other serious illnesses, 5 and that oncologists are becoming increasingly accepting of patients using cannabis, despite their continued concerns regarding its safety and efficacy. 6,7 For example, approximately 46% of oncologists reported recommending medical cannabis clinically and approximately 80% discussed it with their patients, despite the fact that approximately 70% acknowledged that they were insufficiently educated regarding medical cannabis. 8 Thus, there appears to be a disconnect between medical cannabis's legal status and high acceptance by patients, recommendations from clinicians, and a poor evidence base concerning its safety and efficacy.A more complete and nuanced understanding of the relevant issues is imperative in this current climate of growing cannabis availability and acceptance. In this commentary, we have discussed key clinical issues related to the efficacy and safety of cannabis in patients with cancer and noted important lingering questions for clinical practice and research in this area. Cannabis: Indications, Use Versus Evidence BaseApproximately 75% of individuals with cancer use cannabis for symptom management, most commonly pain, nausea, and sleep disruption 9,10 ; however, to the best of our knowledge, the evidence base supporting this has been limited. It is important to note at the outset that the majority of the cannabis research conducted in oncology patients lacks the rigor that would be required of most other oncology treatments in practice. Even the limited number of randomized controlled trials that exist for comparing the efficacy of cannabis with that of placebo or other drugs in oncologic patients are homogeneously low or very low in quality. 11 A recent systematic review characterized the available evidence regarding cannabis for cancer symptom management as low quality and found no benefit for its common indications of pain, sleep, or a reduction of opioid dose. 12 In addition, to our knowledge, evidence for the antiemetic properties of plantbased preparations is seriously lacking. In effect, the best evidence exists for oral, pharmaceutically prepared, synthetic tetrahydrocannabinols (THCs) such as nabilone and dronabinol, which have been found to be superior to placebo and equivalent to other antiemetic medications. [13][14][15] For example, one observational prospective study found at least a 30% reduction in symptoms such as vomiting and fatigue ...

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“…Recent studies suggested that some cannabinoid-based treatments might have antitumor properties. [2][3][4][5] Cannabinoids were found to modulate key cell signaling pathways involved in the control of cancer cell proliferation and survival. [6][7][8] However, most of these studies utilized in vitro methods, a few were done in immune-competent animal models, and the data from human patients are anecdotal.…”

Section: Cannabis and Cancermentioning

confidence: 99%

“…In addition, the heterogeneity of endocannabinoids and their receptors in different tumor types raises the possibility that specific cannabinoid compositions should be used to treat differing cancer subtypes. 3,9,10…”

Section: Cannabis and Cancermentioning

confidence: 99%

The Highs and Lows of Cannabis in Cancer Treatment and Bone Marrow Transplantation

Almogi-Hazan

Khuja

Ritter³

et al. 2020

Rambam Maimonides Med J

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In the last decade, we have observed an increased public and scientific interest in the clinical applications of medical cannabis. Currently, the application of cannabinoids in cancer patients is mainly due to their analgesic and anti-emetic effects. The direct effects of phyto-cannabinoids on cancer cells are under intensive research, and the data remain somewhat inconsistent. Although anti-proliferative properties were observed in vitro, conclusive data from animal models and clinical trials are lacking. Since immunotherapy of malignant diseases and bone marrow transplantation are integral approaches in hemato-oncology, the immuno-modulatory characteristic of cannabinoids is a fundamental aspect for consideration. The effect of cannabinoids on the immune system is presently under investigation, and some evidence for its immunoregulatory properties has been shown. In addition, the interaction of cannabinoids and classical cytotoxic agents is a subject for further investigation. Here we discuss the current knowledge of cannabinoid-based treatments in preclinical models and the limited data in oncological patients. Particularly, we address the possible contradiction between the direct anti-tumor and the immune-modulatory effects of cannabinoids.

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The heterogeneity and complexity of Cannabis extracts as antitumor agents

Cited by 83 publications

References 51 publications

Cannabinoid and Terpenoid Doses are Associated with Adult ADHD Status of Medical Cannabis Patients

Cannabinoid and Terpenoid Doses are Associated with Adult ADHD Status of Medical Cannabis Patients

Medical cannabis use among individuals with cancer: An unresolved and timely issue

The Highs and Lows of Cannabis in Cancer Treatment and Bone Marrow Transplantation

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