No relief yet for brutal oral cancer pain, but cannabinoids may offer some hope

May 3, 2014

Science Daily/American Pain Society

Many cancer patients endure severe pain and, by far, one of the most excruciating pain conditions is caused by oral cancer, for which even the strongest available pain medications are largely ineffective. One of the nation's leading oral cancer treating clinicians, speaking at the American Pain Society's annual meeting, said he believes that while prospects for major treatment advances remain bleak, a new cannabinoid-based medication may have some promise for providing meaningful pain relief.

Brian Schmidt, DDS, MD, PhD, professor, New York University College of Dentistry and School of Medicine, delivered the Global Year Against Pain Lecture and reported that today, more than 100 years since President Ulysses S. Grant died from oral cancer, there is only modest improvement in patient survival. Grant is the only American president to die from cancer.

"Oral cancer is one of the most painful and debilitating of all malignancies," said Schmidt, " and opioids, the strongest pain medications we have, are an imperfect solution. They become dramatically less effective as tolerance to these drugs develops."

Now considered to be the fastest increasing cancer in the United States, oral and oropharyngeal malignancies usually begin in the tongue. Human papillomavirus transmitted through oral sex, tobacco use and excessive alcohol consumption are the leading causes of this increase in oropharyngeal cancer. In the United States, some 43,000 new cases of oral cancer are diagnosed every year and the disease is more widespread worldwide with 640,000 new cases a year.

Schmidt said oral cancer patients often undergo multiple surgeries as tumors recur and also are treated with radiation and chemotherapy. The disease is difficult to diagnose at early stages and spreads quickly, leaving patients in gruesome pain and unable to speak or swallow. "Our inability to effectively treat oral cancer stems from lack of knowledge. We know that cancer pain is caused by a unique biological mechanism, but more research is needed to develop medications that are effective in treating oral cancer pain," Schmidt said.

"The only way we can hope to reduce the devastating impact of oral cancer pain is to fund more research to help those who suffer or will suffer from this ruthless disease," Schmidt told the APS audience. He added that half of oral cancer patients do not survive five years after diagnosis.

Schmidt noted that perhaps some good news is on the horizon, as clinical trials proceed for a drug produced directly from a marijuana plants (Sativex). It is administered as an oral spray and shows promise for treating cancer pain. The drug is available in Canada and Europe for treating spasticity from multiple sclerosis and is in Phase 3 clinical trials in the United States for treatment of cancer pain. Schmidt is a clinical investigator for Sativex trials.

"While it's too early to conclude the cannabinoid medication will provide effective cancer pain relief, we do know that humans possess numerous cannabinoid receptors in the brain and body which regulate a significant amount of human physiology. So, there is hope that cannabinoid-based medications can become effective pain relievers for cancer patients."

https://www.sciencedaily.com/releases/2014/05/140503141201.htm

Patients with or without cancer use different forms of marijuana

March 26, 2019

NYU Langone Health / NYU School of Medicine

People with and without cancer are more likely, over time, to use a more potent form of medical marijuana with increasingly higher amounts of tetrahydrocannabinol (THC), a new study shows.

In a report publishing in the Journal of Palliative Medicine on March 26, researchers say that cancer patients were more likely to favor forms of medical marijuana with higher amounts of THC, which relieves cancer symptoms and the side effects of cancer treatment, including chronic pain, weight loss, and nausea.

By contrast, marijuana formulations higher in cannabidiol (CBD), which has been shown to reduce seizures and inflammation in other studies, were more popular among non-cancer patients, including those with epilepsy and multiple sclerosis, say the study authors.

Cancer patients were also more likely to prefer taking oil droplets containing medical marijuana under the tongue than "vaping."

"Although there is growing patient interest in medical cannabis, there is a scarcity of solid evidence about the benefits, risks, and patterns of use of marijuana products in various disease settings," says study lead investigator Arum Kim, MD, an assistant professor of medicine and rehabilitation medicine at NYU School of Medicine and director of the supportive oncology program at its Perlmutter Cancer Center. "Such information is important for delivering the best care."

Since 1996, 31 states, including New York in 2014, have legalized medical marijuana.

For the study, researchers analyzed data from 11,590 men and women in New York, of whom 1,990 (17.2 percent of the total patient cohort) were cancer patients who purchased and used cannabis products from Columbia Care LLC., a dispensary licensed in New York State, between January 2016 and December 2017.

The researchers caution that their data did not include the type of cancer the purchasers had, how much of what they bought was used, or whether marijuana was used for symptoms unrelated to the cancer. Nevertheless, the patterns of use among cancer patients were distinctly different from those of non-cancer patients.

Specifically, the study found that cancer and non-cancer patients used different dosages of cannabis formulations with dramatically different THC:CBD ratios. The two most common formulations contained THC and CBD, but one had twenty times more THC than CBD, whereas the other had the opposite ratio.

Over the two years of the study, the research team found that all types of patients increased their THC dose by approximately 0.20 milligrams per week.

"Our study provides valuable new information about how cancer patients are using marijuana," says study senior investigator Benjamin Han, MD, MPH, an assistant professor of medicine and population health at NYU School of Medicine. "In the absence of strong clinical research data for medical marijuana, identifying patterns of use offers some sense of how to guide patients who come in with questions for using medical marijuana, and what may or may not help them."

Researchers say they next plan to get more detailed information about how medical marijuana affects patient response to therapy and functional status at different stages of their disease, as well as the risks and side effects of treatment. Furthermore, the profiles of other cannabinoids besides THC and CBD in medical marijuana products warrant further research, according to the study authors.

Along with Kim and Han, another co-author from NYU School of Medicine and Perlmutter Cancer Center, which funded the study, was Zujun Li, MD. Other study authors include Christopher Kaufmann, PhD, MHS, at University of California San Diego; and Roxanne Ko, BA, BS, at the University of Hawaii.

https://www.sciencedaily.com/releases/2019/03/190326081343.htm

Up to one-quarter of cancer patients use marijuana

September 25, 2017

Science Daily/Wiley

A new study conducted in a cancer center in a state with legalized medicinal and recreational marijuana found that approximately one-quarter of surveyed patients used marijuana in the past year, mostly for physical and psychological symptoms. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the study also revealed that legalization increased the likelihood for use among patients.

Eight states and the District of Columbia have legalized recreational marijuana, and over half the states in the U.S. have passed laws allowing for medical marijuana in some form. As availability and acceptance of marijuana use continue to increase, many cancer patients will have greater access to marijuana during their cancer treatment.

Marijuana is purported to alleviate symptoms related to cancer treatment, but patterns of use among cancer patients are not well known. To investigate, Steven Pergam, MD, MPH, of the Fred Hutchinson Cancer Research Center and his colleagues surveyed 926 patients at the Seattle Cancer Center Alliance.

The team found that most patients had a strong interest in learning about marijuana during treatment and 74 percent wanted information from cancer care providers. Sixty-six percent had used marijuana in the past, 24 percent used in the last year, and 21 percent used in the last month. Most current users smoked or consumed marijuana primarily for physical symptoms (such as pain and nausea) or psychological reasons (such as coping with stress, depression, and insomnia).

The study reports that random analysis of patient urine samples showed that 14 percent had evidence of recent cannabis use, similar to the 18 percent of users who reported use within the past week.

Although nearly all respondents wanted more information directly from their doctors, most reported that they were more likely to get information from sources outside of the healthcare system. "Cancer patients desire but are not receiving information from their cancer doctors about marijuana use during their treatment, so many of them are seeking information from alternate non-scientific sources," said Dr. Pergam. He stressed that marijuana may be dangerous for some cancer patients or lead to unwanted side effects. "We hope that this study helps to open up the door for more studies aimed at evaluating the risks and benefits of marijuana in this population. This is important, because if we do not educate our patients about marijuana, they will continue to get their information elsewhere."

https://www.sciencedaily.com/releases/2017/09/170925095431.htm