Pharmacokinetics of Cannabis in Cancer Cachexia-Anorexia Syndrome

Abstract

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.

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Correspondence to Jennifer H. Martin.

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No funding was provided for this manuscript. Government funding for rigorous clinical trials in medicinal cannabis use have been provided for research projects in New South Wales, Australia.

Conflicts of interest

Jennifer H. Martin and Stephanie E. Reuter are part of the New South Wales Government-funded phase II project team in clinical pharmacology for a study commencing in 2016. Jennifer H. Martin is funded by the University of Newcastle and Calvary Mater Hospital, NSW, Australia, and Stephanie E. Reuter receives funds from the National Health and Medical Research Council, University of South Australia and University of Newcastle.

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Reuter, S.E., Martin, J.H. Pharmacokinetics of Cannabis in Cancer Cachexia-Anorexia Syndrome. Clin Pharmacokinet 55, 807–812 (2016). https://doi.org/10.1007/s40262-015-0363-2

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Keywords

  • Cancer Cachexia
  • Cannabidiol
  • Nabilone
  • Dronabinol
  • Cannabis Extract