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Grimison P, Mersiades A, Kirby A, Tognela A, Olver I, Morton RL, Haber P, Walsh A, Lee Y, Abdi E, Della-Fiorentina S, Aghmesheh M, Fox P, Briscoe K, Sanmugarajah J, Marx G, Kichenadasse G, Wheeler H, Chan M, Shannon J, Gedye C, Begbie S, Simes RJ, Stockler MR. Oral Cannabis Extract for Secondary Prevention of Chemotherapy-Induced Nausea and Vomiting: Final Results of a Randomized, Placebo-Controlled, Phase II/III Trial. J Clin Oncol 2024:JCO2301836. [PMID: 39151115 DOI: 10.1200/jco.23.01836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/20/2023] [Accepted: 06/12/2024] [Indexed: 08/18/2024] Open
Abstract
PURPOSE The aim of this randomized, placebo-controlled, two-stage, phase II/III trial was to determine the efficacy of an oral cannabis extract in adults with refractory nausea and/or vomiting during moderately or highly emetogenic, intravenous chemotherapy despite guideline-consistent antiemetic prophylaxis. Here, we report results of the prespecified combined analysis including the initial phase II and subsequent phase III components. PATIENTS AND METHODS Study treatment consisted of oral capsules containing either tetrahydrocannabinol 2.5 mg plus cannabidiol 2.5 mg capsules (THC:CBD) or matching placebo, taken three times a day from days -1 to 5, in addition to guideline-consistent antiemetics. The primary measure of effect was the difference in the proportions of participants with no vomiting or retching and no use of rescue medications (a complete response) during hours 0-120 after the first cycle of chemotherapy on study (cycle A). RESULTS We recruited 147 evaluable of a planned 250 participants from 2016 to 2022. Background antiemetic prophylaxis included a corticosteroid and 5-hydroxytryptamine antagonist in 97%, a neurokinin-1 antagonist in 80%, and olanzapine in 10%. THC:CBD compared with placebo improved the complete response rate from 8% to 24% (absolute difference 16%, 95% CI, 4 to 28, P = .01), with similar effects for absence of significant nausea, use of rescue medications, daily vomits, and the nausea scale on the Functional Living Index-Emesis quality-of-life questionnaire. More frequent bothersome adverse events of special interest included sedation (18% v 7%), dizziness (10% v 0%), and transient anxiety (4% v 1%). There were no serious adverse events attributed to THC:CBD. CONCLUSION THC:CBD is an effective adjunct for chemotherapy-induced nausea and vomiting despite standard antiemetic prophylaxis, but was associated with additional adverse events. Drug availability, cultural attitudes, legal status, and preferences may affect implementation. Future analyses will evaluate the cost-effectiveness of THC:CBD.
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Affiliation(s)
- Peter Grimison
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Antony Mersiades
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Dept of Medical Oncology, Northern Beaches Hospital, Frenchs Forest, NSW, Australia
| | - Adrienne Kirby
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Annette Tognela
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Ian Olver
- University of Adelaide, Adelaide, SA, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Paul Haber
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Anna Walsh
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Yvonne Lee
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - Morteza Aghmesheh
- Department of Medical Oncology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Peter Fox
- Dept of Medical Oncology, Orange Base Hospital, Orange, NSW, Australia
| | - Karen Briscoe
- Department of Medical Oncology, Coffs Harbour Hospital, Coffs Harbour, NSW, Australia
| | - Jasotha Sanmugarajah
- Department of Medical Oncology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Gavin Marx
- Department of Medical Oncology, Sydney Adventist Hospital, Wahroonga, NSW, Australia
| | | | - Helen Wheeler
- Department of Medical Oncology, Royal North Shore Hospital, Gosford, NSW, Australia
| | - Matthew Chan
- Department of Medical Oncology, Gosford Hospital, Gosford, NSW, Australia
| | - Jenny Shannon
- Department of Medical Oncology, Nepean Hospital, Kingswood, NSW, Australia
| | - Craig Gedye
- Department of Medical Oncology, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Stephen Begbie
- Department of Medical Oncology, Port Macquarie Hospital, Port Macquarie, NSW, Australia
| | - R John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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Castillo-Arellano J, Canseco-Alba A, Cutler SJ, León F. The Polypharmacological Effects of Cannabidiol. Molecules 2023; 28:3271. [PMID: 37050032 PMCID: PMC10096752 DOI: 10.3390/molecules28073271] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023] Open
Abstract
Cannabidiol (CBD) is a major phytocannabinoid present in Cannabis sativa (Linneo, 1753). This naturally occurring secondary metabolite does not induce intoxication or exhibit the characteristic profile of drugs of abuse from cannabis like Δ9-tetrahydrocannabinol (∆9-THC) does. In contrast to ∆9-THC, our knowledge of the neuro-molecular mechanisms of CBD is limited, and its pharmacology, which appears to be complex, has not yet been fully elucidated. The study of the pharmacological effects of CBD has grown exponentially in recent years, making it necessary to generate frequently updated reports on this important metabolite. In this article, a rationalized integration of the mechanisms of action of CBD on molecular targets and pharmacological implications in animal models and human diseases, such as epilepsy, pain, neuropsychiatric disorders, Alzheimer's disease, and inflammatory diseases, are presented. We identify around 56 different molecular targets for CBD, including enzymes and ion channels/metabotropic receptors involved in neurologic conditions. Herein, we compiled the knowledge found in the scientific literature on the multiple mechanisms of actions of CBD. The in vitro and in vivo findings are essential for fully understanding the polypharmacological nature of this natural product.
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Affiliation(s)
- Jorge Castillo-Arellano
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA
| | - Ana Canseco-Alba
- Laboratory of Reticular Formation Physiology, National Institute of Neurology and Neurosurgery of Mexico (INNN), Mexico City 14269, Mexico
| | - Stephen J. Cutler
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA
| | - Francisco León
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA
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