Cannabinoids in the Treatment of Chemotherapy-Induced Nausea and Vomiting

Author:
Barbara Todaro From Roswell Park Cancer Institute, Buffalo, New York. Submitted October 17, 2011; accepted for publication December 14, 2011.

Search for other papers by Barbara Todaro in
Current site
Google Scholar
PubMed
Close
 PharmD
Restricted access

Before the introduction of the serotonin receptor antagonists (5-HT3 receptor antagonists) in the early 1990s, limited effective options were available to prevent and treat chemotherapy-induced nausea and vomiting (CINV). In 1985, the FDA approved 2 cannabinoid derivatives, dronabinol and nabilone, for the treatment of CINV not effectively treated by other agents. Today, the standard of care for prevention of CINV for highly and moderately emetogenic chemotherapy is a 5-HT3 receptor antagonist, dexamethasone, with or without aprepitant or fosaprepitant. With the approval of safer and more effective agents, cannabinoids are not recommended as first-line treatment for the prevention of CINV and are reserved for patients with breakthrough nausea and vomiting. Because of medical and legal concerns, the use of marijuana is not recommended for management of CINV and is not part of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Antiemesis. Although patients may like to pursue this treatment option in states that have approved the use of marijuana for medical purposes, its use remains legally and therapeutically controversial.

Correspondence: Barbara Todaro, PharmD, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263. E-mail: barbara.todaro@roswellpark.org
  • Collapse
  • Expand
  • 1

    Ettinger DS, Armstrong DK, Barbour S et al.. NCCN Clinical Practice Guidelines in Oncology for Antiemesis. Version 1, 2012. Available at: http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf. Accessed January 31, 2012.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med 2008;358:24822494.

  • 3

    Kris MG, Hesketh PJ, Somerfield MR et al.. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 2006;24:29322946.

  • 4

    Roila R, Herrstedt J, Aapro M et al.. Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 2010;21(Suppl 5):v232243.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Darmani NA. Mechanism of broad-spectrum antiemetic efficacy of cannabinoids against chemotherapy-induced acute and delayed vomiting. Pharmaceuticals 2010;3:29302955.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Parker LA, Rock EM, Limebeer CL. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol 2011;163:14111422.

  • 7

    Tramer MR, Carroll D, Campbell FA et al.. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systemic review. BMJ 2001;323:1621.

  • 8

    Rocha FC, Stefano SC, De Cassia Haiek R et al.. Therapeutic use of Cannabis sativa on chemotherapy-induced nausea and vomiting among cancer patients: systemic review and meta-analysis. Eur J Cancer Care (Engl) 2008;17:431443.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Ahmedzai S, Carlyle DL, Calder IT, Moran F. Anti-emetic efficacy and toxicity of nabilone, a synthetic cannabinoid, in lung cancer chemotherapy. Br J Cancer 1983;48:657664.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Crawford SM, Buckman R. Nabilone and metoclopramide in the treatment of nausea and vomiting due to cisplatinum: a double blind study. Med Oncol Tumor Pharmacother 1986;3:3942.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Pomeroy M, Fennelly JJ, Towers M. Prospective randomized double-blind trial of nabilone versus domperidone in the treatment of cytotoxic-induced emesis. Cancer Chemother Pharmacol 1986;17:285288.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Herman TS, Einhorn LH, Jones SE et al.. Superiority of nabilone over prochlorperazine as an antiemetic in patients receiving cancer chemotherapy. N Engl J Med 1979;300:12951297.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Sallan S, Zinberg NE, Frei E III. Antiemetic effect of delta-9-tetrahydrocannabinoll in patients receiving cancer chemotherapy. N Engl J Med 1975;293:795797.

  • 14

    Pacula RL, Chriqui JF, Reichmann DA, Terry-McElrath TM. State medical marijuana laws: understanding the laws and their limitations. J Public Health Policy 2002;23:413439.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Controlled Substances Act. U.S. Food and Drug Administration Web site. Available at: http://www.fda.gov/RegulatoryInformation/Legislation/ucm148726.htm. Accessed January 30, 2012.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Okie S. Medical marijuana and the Supreme Court. N Engl J Med 2005;353:648651.

  • 17

    Gonzalez v Raich, 545 US 1(2005).

  • 18

    Schwartz RH, Voth EA, Sheridan MJ. Marijuana to prevent nausea and vomiting in cancer patients: a survey of oncologists. South Med J 1997;90:167172.

  • 19

    de Jong FA, Engels KF, Mathijessen RH et al.. Medical cannabis in oncology practice: still a bridge too far? J Clin Oncol 2005;23:28862891.

  • 20

    Joy JE, Watson SJ, Benson JA Jr, eds. Marijuana and Medicine: Assessing the Science Base. Washington, DC: National Academy Press; 1999. Available at: http://books.nap.edu/catalog/6376.html. Accessed October 6, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Marijuana. American Cancer Society Web site. Available at: http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/marijuana. Accessed October 6, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Seamon MJ, Fass JA, Maniscalco-Feichtl M, Abu-Shraie NA. Medical marijuana and the developing role of the pharmacist. Am J Health Syst Pharm 2007;64:10371045.

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 7000 2138 206
PDF Downloads 2649 482 24
EPUB Downloads 0 0 0