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Medical cannabis in symptomatic therapy of oncology patients

Cannabis sativa L. (Cannabaceae) is one of the first plants cultivated by man and one of the oldest plant sources of fi bre, food and remedies. To date, 750 constituents have been identified from cannabis. Out of those 750 over 100 are classified as cannabinoids, a unique group of terpenophenolic secondary metabo- lites. The principal active constituent is delta-9-tetrahydrocannabinol (THC) which binds to endocannabi- noid receptors to exert its pharmacological activity, including its psychoactive effect. The other important molecule of current interest is non-psychotropic cannabidiol (CBD). Research of cannabis medical proper- ties has gained worldwide interest after the discovery of two types of cannabinoid receptors, which are G-protein coupled receptors specifically responding to endocannabinoids, phytocannabinoids and related synthetic cannabimimetic compounds. The medical use of cannabis is still controversial and strongly lim- ited by unavoidable psychotropic effects. However, solid scientific data indicated the potential of thera- peutic value of cannabis in controlling some forms of pain, relieving chemotherapy induced nausea and vomiting (CINV) as well as treating cachexia and anorexia with no evidence that giving cannabis to the patients would increase illicit drug use in the general population. Various clinical studies have confi rmed the antiemetic effect of cannabinoids in patients with CINV. It has been reported that cancer patients downsized opioid dose after adding cannabis in their pain therapy regimen. Poor chemotherapy response and decreased survival is often connected with cachexia. The majority of clinical studies dealing with cachexia and anorexia are focused on AIDS patients, but there is some clinical evidence that cannabinoids could be beneficial for patients with cancer-associated anorexia/cachexia. In conclusion, cannabis and can- nabinoids have an acceptable safety profile with side effects which are generally tolerable and reversible. They also show positive results in various clinical trials considering treatment of nausea, vomiting, pain and anorexia/cachexia. Further clinical trials are essential for clearly defining the role of medical cannabis in symptomatic therapy of oncology patients.

Cannabis sativa, oncology, pain, nausea, cachexia

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