Cannabinoide in der Palliativtherapie des Anorexie-Kachexie-Syndroms

Cannabinoids in the treatment of the cachexia-anorexia syndrome in palliative care patients

Zusammenfassung

Appetitlosigkeit und Kachexie sind häufige, aber bis zum heutigen Tag nur wenig beeinflussbare Symptome in der Palliativmedizin, die bei vielen Patienten zu einer deutlichen Beeinträchtigung der Lebensqualität führen. Die Ursachen und die Pathophysiologie von Anorexie und Kachexie sind komplex. Vor einer medikamentösen Therapie müssen Ursachen erfasst und behandelt werden. Die pharmakologische symptomatische Behandlung zielt auf die Beeinflussung der metabolischen, neuroendokrinen und katabolen Veränderungen ab. Neben dem Einsatz von Prokinetika, Kortikosteroiden und Gestagenen werden in letzter Zeit auch Cannabinoide auf ihre Eignung zur Appetitsteigerung und Gewichtszunahme untersucht. Bei Tumorpatienten waren Cannabinoide deutlich effektiver als Placebo, aber eher schwächer als Gestagene. Bei Patienten mit AIDS oder Morbus Alzheimer konnte im Vergleich zu Placebo ebenfalls eine höhere Effektivität nachgewiesen werden. Nebenwirkungen wie Schwindel, Müdigkeit und Benommenheit führten bei einem Teil der Patienten zum Abbruch der Cannabinoidtherapie.

Abstract

Loss of appetite and cachexia are frequent symptoms in palliative care patients. However, therapeutic regimens often prove ineffective, and the quality of life of many patients is significantly impaired by these symptoms. Causes and pathophysiology of anorexia and cachexia are complex and must be identified and treated. Symptomatic pharmacological therapy aims at metabolic, neuroendocrinological and catabolic changes. Prokinetic drugs, corticosteroids and gestagenes are used for symptomatic therapy. Recently, the use of cannabinoids for treatment of loss of appetite and cachexia has become the focus of interest. In cancer patients, cannabinoids proved more effective than placebo but less than gestagenes. Compared to placebo, higher efficacy of cannabinoids could be demonstrated in patients with AIDS as well as in patients with Morbus Alzheimer. However, side effects, such as dizziness, tiredness and daze led to discontinuation of the cannabinoid therapy in some patients.

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Literatur

  1. 1.

    Beal JA (1994) Appetite effect of dronabinol. J Clin Oncol 12(7):1524–1525

    CAS  PubMed  Google Scholar 

  2. 2.

    Beal JE, Olson R, Laubenstein L, Morales JO, Bellman P, Yangco B, Lefkowitz L, Plasse TF, Shepard KV (1995) Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. J Pain Symptom Manage 10(2):89–97

    CAS  PubMed  Google Scholar 

  3. 3.

    Beal JE, Olson R, Lefkowitz L, Laubenstein L, Bellman P, Yangco B, Morales JO, Murphy R, Powderly W, Plasse TF, Mosdell KW, Shepard KV (1997) Long-term efficacy and safety of dronabinol for acquired immunodeficiency syndrome-associated anorexia. J Pain Symptom Manage 14(1):7–14

    CAS  PubMed  Google Scholar 

  4. 4.

    Bozzetti F, Amadori D, Bruera ED et al. (1996) Guidelines on artificial nutrition versus hydration in terminal cancer patients. European Association for Palliative Care. Nutrition 12(3):163–167

    CAS  PubMed  Google Scholar 

  5. 5.

    Curtis EB, Krech R, Walsh TD (1991) Common symptoms in patients with advanced cancer. J Palliat Care 7(2):25–29

    CAS  Google Scholar 

  6. 6.

    Ettinger AB, Portenoy RK (1988) The use of corticosteroids in the treatment of symptoms associated with cancer (review) J Pain Symptom Manage 3(2):99–103

    Google Scholar 

  7. 7.

    James JS (2000) Marijuana safety study completed: weight gain, no safety problems. AIDS Treat News 4(348):3–4

    Google Scholar 

  8. 8.

    Jatoi A, Windschitl HE, Loprinzi CL, Sloan JA, Dakhil SR, Mailliard JA, Pundaleeka S, Kardinal CG, Fitch TR, Krook JE, Novotny PJ, Christiansen B (2002) Dronabinol versus megesterol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group Study. J Clin Oncol 20(2):567–573

    CAS  PubMed  Google Scholar 

  9. 9.

    Kalant H (2001) Medicinal use of cannabis: history and current status. Pain Res Manag 6 (2):80–91

    CAS  PubMed  Google Scholar 

  10. 10.

    Klein S, Koretz RL (1994) Nutrition support in patients with cancer: what do the data really show? Nutr Clin Pract 9(3):91–100

    CAS  PubMed  Google Scholar 

  11. 11.

    Langstein HN, Norton JA (1991) Mechanisms of cancer cachexia. Hematol Oncol Clin North Am 5:103–123

    CAS  PubMed  Google Scholar 

  12. 12.

    Loprinzi CL, Michalak JC, Schaid DJ et al. (1993) Phase III evaluation of four doses of megesterol acetate as therapy for patients with cancer anorexia and/or cachexia. J Clin Oncol 11(4):762–767

    CAS  PubMed  Google Scholar 

  13. 13.

    Mantovani G, Maccio A, Esu S et al. (1997) Medroxyprogesterone acetate reduces the production of cytokines and serotonin involved in anorexia/cachexia and emesis by peripheral blood mononuclear cells of cancer patients [abstr]. Biochem Soc Trans 25:296

    Google Scholar 

  14. 14.

    Mildner T (1972) Hashish and its evaluation during 1000 years [Haschisch in der Bewertung von 1000 Jahren.] Dtsch Med J 10;23(9):XXVI passim

  15. 15.

    Nahas GG (1982) Hashish in Islam 9th to 18th century. Bull N Y Acad Med 58 (9):814–831

    CAS  PubMed  Google Scholar 

  16. 16.

    Nelson KA, Walsh TD (1993) Metoclopramide in anorexia caused by cancer-associated dyspepsia syndrome (CADS). J Palliat Care 9(2):14–18

    CAS  Google Scholar 

  17. 17.

    Nelson K, Walsh D, Deeter P, Sheehan F (1994) A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer-associated anorexia. J Palliat Care 10(1):14–18

    CAS  Google Scholar 

  18. 18.

    Plasse TF, Gorter RW, Krasnow SH (1991) Recent clinical experience with dronabinol. Pharmacol Biochem Behav 40:695–700

    Google Scholar 

  19. 19.

    Regelson W, Butler JR, Schulz J, Kirk T, Peck L, Green ML (1976) Delta-9-tetrahydrocannabinol (delta-9-THC) as an effective antidepressant and appetite-stimulating agent in advanced cancer patients. In: Braude MC, Szara S (eds) The pharmacology of marijuana. Raven Press, New York, pp 763–766

  20. 20.

    Schnelle M, Grotenhermen F, Reif M, Gorter RW (1999) [Results of a standardized survey on the medical use of cannabis products in the German-speaking area]. Forsch Komplementarmed 6 [suppl 3]:28–36

    Google Scholar 

  21. 21.

    Strasser F, Bruera ED (2002) Update on anorexia and cachexia. Hematol Oncol Clin North Am 16:589–617

    PubMed  Google Scholar 

  22. 22.

    Turner CE, Elsohly MA, Boeren EG (1980) Constituents of Cannabis sativa L.XVII. A review of the natural constituents. J Nat Prod 43:169–234

    CAS  PubMed  Google Scholar 

  23. 23.

    Volicer L, Stelly M, Morris J, McLaughin J, Volicer BJ (1997) Effects of dronabinol on anorexia and disturbed behavior in patients with Alzheimer’s disease. Int J Geriatr Psychiatry 12(9):913–919

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Winter SM (2000) Terminal nutrition: framing the debate for the withdrawl of nutritional support in terminally ill patients [review]. Am J Med 109(9):723–726

    CAS  PubMed  Google Scholar 

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Correspondence to Dr. F. Nauck.

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Nauck, F., Klaschik, E. Cannabinoide in der Palliativtherapie des Anorexie-Kachexie-Syndroms. Schmerz 18, 197–202 (2004). https://doi.org/10.1007/s00482-003-0277-z

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Schlüsselwörter

  • Cannabinoide
  • Palliativmedizin
  • Anorexie
  • Kachexie
  • Appetitlosigkeit

Keywords

  • Cannabinoids
  • Palliative care
  • Anorexia
  • Cachexia
  • Loss of appetite