Integrating cannabis into clinical cancer care
Integrating cannabis into clinical cancer care
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DOI：
10.3747/co.23.3099
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发表时间：
2016-03-01
期刊：
影响因子：
2.6
通讯作者：
Abrams, D. I.
中科院分区：
文献类型：
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作者：
Abrams, D. I.
大麻品种作为药物已有数千年的历史。直到 20 世纪 40 年代，这种植物才被广泛用于医疗用途。然而，越来越多的司法管辖区正在使患者能够获得药用植物。对于癌症患者来说，大麻有许多潜在的好处，特别是在症状管理方面。大麻可有效对抗厌食症、化疗引起的恶心和呕吐、疼痛、失眠和抑郁症。大麻可能不如其他可用的止吐药有效，但对于某些患者来说，它是唯一有效的药物，也是唯一能增加食欲的止吐药。在许多情况下，吸入大麻在改善周围神经病变方面比安慰剂更有效，并且可能对化疗引起的神经病变有用。一项对慢性疼痛患者服用稳定剂量的缓释阿片类药物的汽化大麻的药代动力学相互作用研究表明，血浆阿片类药物没有临床上显着的变化，同时提示了协同镇痛的可能性。除了症状管理之外，越来越多的体外和动物模型研究支持大麻素通过多种不同机制可能具有直接抗癌作用，其中包括： 细胞凋亡、血管生成和抑制转移。尽管缺乏临床试验，但大量轶事报告描述患者对大麻作为抗癌剂有显着反应，特别是当作为高效口服浓缩物服用时。应进行人体研究来解决与上述影响相关的关键问题。
Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are making it possible for patients to obtain the botanical for medicinal use.For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite. Inhaled cannabis is more effective than placebo in ameliorating peripheral neuropathy in a number of conditions, and it could prove useful in chemotherapy-induced neuropathy. A pharmacokinetic interaction study of vaporized cannabis in patients with chronic pain on stable doses of sustained-release opioids demonstrated no clinically significant change in plasma opiates, while suggesting the possibility of synergistic analgesia.Aside from symptom management, an increasing body of in vitro and animal-model studies supports a possible direct anticancer effect of cannabinoids by way of a number of different mechanisms involving apoptosis, angiogenesis, and inhibition of metastasis. Despite an absence of clinical trials, abundant anecdotal reports that describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency orally ingested concentrate, are circulating. Human studies should be conducted to address critical questions related to the foregoing effects.