cannabidiol and Cachexia

Appetite influences perceived quality of life for a dog or cat with cancer. Inappetence often is multifactorial, complicating treatment. Cancer-related anorexia/cachexia syndrome is a metabolic, paraneoplastic syndrome characterized by decreased food intake, involuntary weight loss, and loss of fat and muscle. If weight loss/cachexia has an impact on canine and feline cancer patients as in humans, management may improve survival times and quality of life. The challenge is having effective, proved therapies available for clinical use. Recent Food and Drug Administration approvals for appetite stimulation have renewed interest and discussion and has the potential to alter the course of case management.

Topics: Animals; Anorexia; Antineoplastic Combined Chemotherapy Protocols; Appetite Stimulants; Cachexia; Cannabidiol; Cat Diseases; Cats; Chronic Disease; Dog Diseases; Dogs; Neoplasms; Quality of Life

Anorexia can affect up to 90 % of people with advanced cancer. It is a complex symptom associated with changes in taste, lack of hunger at mealtimes and lack of food enjoyment. Associated weight loss is part of the physical decline that occurs as cancer worsens. Weight loss can also occur from cachexia, the increased metabolism of energy due to raised inflammatory cytokines, liver metastases and other factors seen in several advanced cancers. Independent of anorexia, although frequently associated (where it is referred to as the cachexia-anorexia syndrome), it accounts for a significant amount of morbidity and deaths in people with cancer. In particular, quality of life for the patient and the family is significantly affected with this syndrome as it causes anxiety and distress. Therefore, it is important that research into therapies is undertaken, particularly focusing on an understanding of the pharmacokinetic properties of compounds in this cachexic population. Cannabinoids are one such group of therapies that have received a large amount of media focus recently. However, there appears to be a lack on rigorous pharmacokinetic data of these complex and varied compounds in the cachexic population. Similarly, there is a lack of pharmacokinetic data in any population group for the non- tetrahydrocannabinol (THC) and cannabidiol (CBD) cannabinoids (often due to the lack of analytical standards for quantification). This review will thus examine the pharmacokinetics of major cannabinoids i.e. THC and CBD in a cancer population. Overall, based on the current literature, evidence for the use of cannabinoids for the treatment of cancer-related cachexia-anorexia syndrome remains equivocal. A high-quality, rigorous, phase I/II study to elicit pharmacokinetic dose-concentration and concentration-response data, with a clinically acceptable mode of delivery to reduce intrapatient variability and enable more consistent bioavailability is needed in this population.

Topics: Anorexia; Cachexia; Cannabidiol; Dronabinol; Humans; Neoplasms; Quality of Life

Dr. Robert Gorter, a professor at the University of California San Francisco Medical Center, is interviewed about his work organizing clinical trials of a cannabis extract. Gorter hopes to demonstrate that the extract can lead to weight gain in patients with HIV or cancer. Gorter will not pursue drug studies where the compound is smoked because of the strong association between smoking and recreational drug use. Gorter also discusses ethical issues, as well as the issues related to obtaining a reliable and consistent form of cannabis. Contact information is provided.

Topics: Appetite Stimulants; Cachexia; Cannabidiol; Cannabis; Clinical Trials as Topic; Dronabinol; Europe; HIV Infections; Humans; Neoplasms; Phytotherapy; Plant Extracts; United States