cancerquote
It is second to heart disease in the number of Americans who die from the disease.  However, unlike heart disease where the overall number of patients contracting the disease is declining, cancer prevalence is increasing.  Costing the United States healthcare system over $228 billion dollars annually, the financial impact of the disease is enormous; however, the personal toll of the disease is even more taxing.  Most cancer treatments have a high therapeutic index, narrowly walking the line between killing the tumor and killing the patient.  The need exists for improved therapies both for palliative care of patients and disease treatment.

Palliative Care:
The population of the prolonged users of cannabis in a recent study reported significant improvement in all aspects of supportive and palliative oncology care…

“A slight reduction in the need for opioids and antidepressant drugs was seen in the study group. … [T]he improvement in symptoms should push the use of cannabis in the practice of oncology palliative treatment.”

Gil Bar-Sela, The Medical Necessity for Medicinal Cannabis: Prospective, Observational Study Evaluating the Treatment in Cancer Patients on Supportive or Palliative Care [d1]

Click to view chart
Changes in degree of cancer-related symptoms or oncology treatment side effects among patients with continuous cannabis use. (Reference Link):

Grade

First interview

Second interview

Nausea

0

34 (32%)

73 (69%)

1-2

69 (65%)

29 (27%)

3-4

3 (3%)

4 (4%)

Vomiting

0

73 (69%)

98 (92%)

1-2

33 (31%)

8 (8%)

Mood disorders

0

6 (6%)

48 (46%)

1-2

79 (74%)

49 (46%)

3

21 (20%)

9 (8%)

Fatigue

0

3 (3%)

48 (45%)

1-2

47 (44%)

53 (50%)

3-4

56 (53%)

5 (5%)

Weight loss

0

35 (33%)

71 (67%)

1-2

66 (62%)

35 (33%)

3

5 (5%)

0

Anorexia

0

34 (32%)

72 (68%)

1-2

69 (65%)

29 (27%)

3-4

3 (3%)

5 (5%)

Constipation

0

45 (42%)

71 (67%)

1-2

54 (51%)

32 (30%)

3

7 (7%)

3 (3%)

Sexual function

0

26 (25%)

51 (48%)

1-2

30 (28%)

18 (17%)

3

50 (47%)

37 (35%)

Sleep disorders

0

21 (20%)

59 (56%)

1-2

74 (70%)

38 (36%)

3-4

11 (10%)

9 (8%)

Itching

0

72 (68%)

90 (85%)

1-2

30 (28%)

15 (14%)

3

4 (4%)

1 (1%)

Pain

0

20 (19%)

44 (42%)

1-2

32 (31%)

36 (34%)

3-4

54 (51%)

26 (25%)

cancerCancer patients experience a number of debilitating symptoms caused by the progression of the disease and/or treatments to cure the disease.  Patients’ symptoms can include pain, nausea, muscle weakness, depression/anxiety and trouble sleeping.  A wide variety of powerful medications are prescribed for palliative care to cancer patients including strong opioids; however, but these medications do not always provide comfort to the patient.  Many patients report their pain is not adequately treated with opioids.  However, medical cannabis has been found to relieve pain in these populations of cancer patients.  In a 2009 double blind study, a group led by Jeremy Johnson reported “This study shows that THC:CBD extract is efficacious for relief of pain in patients with advanced cancer pain not fully relieved by strong opioids.”

The above finding was not surprising as multiple prior studies had reported pain relief in both animal models and patients administered cannabinoids and/or cannabis.   Reports have also shown a synergistic effect of patients using both opioids and cannabis products.  The synergistic effect is hypothesized to be the result of activation of the both the opioid receptors and the CB1 receptor (cannabinoid receptor) which are both located in the central nervous system and the CB2 receptor (cannabinoid receptor) which is thought to decrease inflammation.  Additionally, cannabinoids and/or cannabis have been found to relieve additional symptoms experienced by patients.  In one clinical trial, patients reported consuming cannabinoids provided pain relief as well as relief of nausea and vomiting as well as better appetite[d2] .

To date, access to medical cannabis for palliative cancer care is difficult.  Many states do not legally provide patient access to medical cannabis.  Physicians struggle with how to prescribe, manage and support patients using medical cannabis due to the limited clinical data and lack of standardized cannabis products.  Patients struggle with inconsistent medical cannabis products, lack of support in navigating the wide variety of medical cannabis products and an industry with little regulation.  Medical cannabis has been shown in multiple studies to relieve pain, nausea and anxiety.  However, all cannabis products are not the same.   At Verda Bio, we are creating CBTs (cannabinoid based therapeutics) that eliminate the barriers encountered by physicians and patients and aid in palliative care.

Cancer Disease Eradication: 

Mini-Reviews in Medicinal Chemistry, that cannabinoids[d3]  “represent a new class of anticancer drugs that retard cancer growth, inhibit angiogenesis [the formation of new blood cells that feed a tumor] and the metastatic spreading of cancer cells.”

Click to view Chart
Tumours that are sensitive to cannabinoid-induced growth inhibition. (Reference Link)
cancertable2graph

spraymedicationAgain, most traditional treatments of cancer have high therapeutic indexes forcing physicians and patients to walk a fine line between life and death.  However, beginning around 2006, researchers began to report the potential antitumoral action of cannabinoids.  In 2006, Spanish scientist Manual Guzman reported that administering pure THC via a catheter into 9 glioblastoma patients resulted in significantly reduced tumor cell proliferation.  Furthermore, Harvard scientist performing a similar study in lung cancer patients reported THC “significantly reduces the ability of the cancer to spread.”  Since these initial studies, several publications have shown inhibition of tumor growth or metastasis.  It is believed that cannabinoids may accomplish this by multiple mechanisms of action including inducing apoptosis and cell cycle arrest and inhibiting angiogenesis.  Studies have shown that this might be accomplished by cannabinoids interacting with critical pathways including AKT, cAMP, ERK, JNK and MAPk.

Additional mechanisms of action have been reported including work completed by Sean McAllister who studied the effects of the cannabinoid, cannabidiol(CBD) on breast cancer cells finding that the compound destroyed malignant cancer cells.  He determined that CBD switched off a gene called ID-1.  ID-1 is a gene found in early embryonic development, but is somehow switched back on in malignant cancer cells.  CBD specifically targets this gene turning it off leading to death of the cancer cells.  Dr. McAllister is quoted as saying “Cannabidiol offers hope of a non-toxic therapy that could treat aggressive forms of cancer without any of the painful side effects of chemotherapy[d4] .”

Over 85 cannabinoids are found in naturally occurring cannabis.  Many are reported to interact synergistically.  However, standardization of cannabis products to enable broad research is difficult.  Researchers, physicians, and patients need access to CBTs (cannabinoid based therapeutics).  Research on the cancer inhibition traits of CBTs is just emerging.  In the last decade, the results have been promising, but by understanding the genome and environmental factors that affect the plant further we can begin to expand understanding of the potential therapeutic compounds found in cannabis.

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