Phytocannabis for the treatment of cancer-related or cancer treatment related symptoms: Evidence Based Review

Download Article

DOI: 10.21522/TIJCR.2014.03.01.Art011

Authors : Kavita Gupta


Cancer is defined as a generic term for a large group of diseases that was observed to affect any part of the body, often characterized by abnormal rapid growth of abnormal cells. According to WHO report, Cancer was the leading cause of morbidity and mortality worldwide. The primary goal of the treatment is to cure cancer or to considerably prolong life, along with improved patient’s quality of life by palliative care, psychological support and alternative treatments. The present report focused on the use of Phytocannabis and its derivatives to alleviate the symptoms occurred due to cancer that included reduced appetite, chemotherapy-induced nausea and vomiting, radiotherapy-induced pain, nausea and vomiting in order to attenuate the disease process. Cancer, Chemotherapy and Radiotherapy-induced emesis and pain, all these mentioned factors led to the interrogation and investigation of the anti-emesis, pain relief, and mood stabilizing properties of Phytocannabis. This study presented the update on health and social consequences of Phytocannabis use, with a focus on the long-term and frequent use of medicinal Cannabis and its derivatives in alleviating the cancer related symptoms. It aimed to present the current knowledge on the impact of Phytocannabis use on health, from its impact on treating cancer related symptoms to its role in chemotherapy and Radiotherapy induced symptoms. This report evaluated the evidence on whether long-term Phytocannabis use is a contributory cause of the following health outcomes: relief from pain, nausea, vomiting, appetite, food taste, night sweats, and adverse physical and mental health effects such as mood swings, fatigue, hallucinations, postural hypotension, dizziness, mind alertness. Thus, the present paper reported of the use of Phytocannabis and its derivatives such as, Nabilone, Delta-9-THC, and Cannabis available in different forms (Oral, Inhaled, Sublingual) on the Quality of life of cancer patients who underwent Chemotherapy treatment and Radiotherapy treatment.

Keywords:‘cannabis’, ‘marijuana’, ‘cannabinoids’, ‘tetrahydrocannabinol’, ‘THC’, ‘dronabinol’, ‘cannabidiol’, ‘CBD’, ‘cannabidivarin’, ’nabilone’, ‘CBDV’, ‘cancer’, ‘chemotherapy’, ‘radiotherapy’ ,‘nausea’ ‘vomiting’, ‘pain’, ‘open-label studies’, Randomized controlled trials’.


[1]     Abrahamov, A., Mechoulam, R. (1995). An efficient new cannabinoid antiemetic in pediatric oncology. Life Sciences, 56(23-24):2097-2102. Available from: .

[2]     Ahmedzai, S., Carlyle, D.L., Calder, I.T., Moran, F. (1983). Anti-emetic efficacy and toxicity of nabilone, a synthetic cannabinoid, in lung cancer chemotherapy. Br J Cancer, 48(5):657-63. Available from: .

[3]     Brisbois, T.D., de Kock, I.H., Watanabe, S.M., Mirhosseini, M., Lamoureux, D.C., Chasen, M., Macdonald, N., Baracos, V.E., Wismer, W.V. (2011). Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial. Ann Oncol., 22(9):2086-93. Available from:

[4]     Cancer (Fact Sheets). Updated February 2015. Accessed on: 2016 June 1. Available from: .

[5]     Chang, A.E., Shiling, D.J., Stillman, R.C., Goldberg, N.H., Seipp, C.A., Barofsky, I., Rosenberg. (1981). A prospective evaluation of delta-9-tetrahydrocannabinol as an antiemetic in patients receiving adriamycin and cytoxan chemotherapy. Cancer, 47(7):1746-51. Available from: .

[6]     Chang, A.E., Shiling, D.J., Stillman, R.C., Goldberg, N.H., Seipp, C.A., Barofsky, I., Simon, R.M., Rosenberg, S.A. (1979). Delta-9-tetrahydrocannabinol as an antiemetic in cancer patients receiving high-dose methotrexate. A prospective, randomized evaluation. Annals of Internal Medicine, 91:819-824. Available from: .

[7]     Chan, H.S., Correia, J.A., MacLeod, S.M. (1987). Nabilone versus prochlorperazine for control of cancer chemotherapy-induced emesis in children: a double-blind, crossover trial. Pediatrics, 79(6):946-52. Available from: .

[8]     Citron, M.L., Herman, T.S., Vreeland, F., Krasnow, S.H., Fossieck, B.E. Jr, Harwood, S., Franklin, R., Cohen, M.H. (1985). Antiemetic efficacy of levonantradol compared to delta-9-tetrahydrocannabinol for chemotherapy-induced nausea and vomiting. Cancer Treat Rep., 69(1):109-12. Available from:

[9]     Côté, M., Trudel, M., Wang, C., Fortin, A. (2015). Improving Quality of Life With Nabilone During Radiotherapy Treatments for Head and Neck Cancers: A Randomized Double-Blind Placebo-Controlled Trial. Ann Otol Rhinol Laryngol, 125(4):317-24. doi: http://10.1177/0003489415612801. [ PubMed PMID: 26503964].

[10]  Cunningham, D., Bradley, C.J., Forrest, G.J., Hutcheon, A.W., Adams, L., Sneddon, M., Harding, M., Kerr, D.J., Soukop, M., Kaye, S.B. (1988). A randomized trial of oral nabilone and prochlorperazine compared to intravenous metoclopramide and dexamethasone in the treatment of nausea and vomiting induced by chemotherapy regimens containing cisplatin or cisplatin analogues. Eur J Cancer Clin Oncol., 24(4):685-9. Available from: .

[11]  Dalzell, A.M., Bartlett, H., Lilleyman, J.S. (1986). Nabilone: an alternative antiemetic for cancer chemotherapy. Arch Dis Child, 61(5):502-5. Available from: .

[12]  Duran, M., Pérez, E., Abanades, S., Vidal, X., Saura, C., Majem, M., Arriola, E., Rabanal, M., Pastor, A., Farré, M., Rams, N., Laporte, J.R., Capellà, D. (2010). Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. Br J Clin Pharmacol., 70(5):656-63. Available from: .

[13]  Einhorn, L.H., Nagy, C., Furnas, B., Williams, S.D. (1981). Nabilone: an effective antiemetic in patients receiving cancer chemotherapy. J Clin Pharmacol, 21(8-9 Suppl):64S-69S. Available from: .

[14]  Engels, F.K., de Jong, F.A., Sparreboom, A., Mathot, R.A., Loos, W.J., Kitzen, J.J., de Bruijn, P., Verweij, J., Mathijssen, R.H. (2007). Medicinal cannabis does not influence the clinical pharmacokinetics of irinotecan and docetaxel. Oncologist, 12(3):291-300. Available from: .

[15]  Epidemiology of cannabis use, disorders and treatment. Updated February 2015. Accessed on: 2016 June 1. Available from: .

[16]  Frytak, S., Moertel, C.G., O'Fallon, J.R., Rubin, J., Creagan, E.T., O'Connell, M.J., Schutt, A.J., Schwartau, N.W. (1979). Delta-9-tetrahydrocannabinol as an antiemetic for patients receiving cancer chemotherapy. A comparison with prochlorperazine and a placebo. Annals of Internal Medicine, 91(6):825-830. Available from: .

[17]  George, M., Pejovic, M.H., Thuaire, M., Kramar, A., Wolff, J.P. (1983). Randomized comparative trial of a new anti-emetic: nabilone, in cancer patients treated with cisplatin. Biomed Pharmacother, 37(1):24-7. Available from: .

[18]  Gonzalez-Rosales, F., Walsh, D. (1997). Intractable nausea and vomiting due to gastrointestinal mucosal metastases relieved by tetrahydrocannabinol (dronabinol). Journal of Pain and Symptom Management, 14(5):311-314. Available from: .

[19]  Gottschling, S. (2011). Cannabinoids in children. Applied pain management and palliative care, 1:55-57. Available from:

[20]  Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. (2009). Available from: .

[21]  Guzman, M., Duarte, M.J., Blazquez, C., Ravina, J., Rosa, M.C., Galve-Roperh, I., Sanchez, C., Velasco, G., Gonzalez-Feria, L. (2006). A pilot clinical study of Delta(9)-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme. Br J Cancer, 95(2):197-203. Available from: .

[22]  Herman, T.S., Einhorn, L.H., Jones, S.E., Nagy, C., Chester, A.B., Dean, J.C., Furnas, B., Williams, S.D., Leigh, S.A., Dorr, R.T., Moon, T. E. (1979). Superiority of nabilone over prochlorperazine as an antiemetic in patients receiving cancer chemotherapy. N Engl J Med., 300(23):1295-7. Available from: .

[23]  Hutcheon, A.W., Palmer, J.B., Soukop, M., Cunningham, D., McArdle, C., Welsh, J., Stuart, F., Sangster, G., Kaye, S., Charlton, D. (1983). A randomised multicentre single blind comparison of a cannabinoid anti-emetic (levonantradol) with chlorpromazine in patients receiving their first cytotoxic chemotherapy. European Journal for Cancer and Clinical Oncology, 19(8):1087-90. Available from: .

[24]  Jatoi, A., Windschitl, H.E., Loprinzi, C.L., Sloan, J.A., Dakhil, S.R., Mailliard, J.A., Pundaleeka, S., Kardinal, C.G., Fitch, T.R., Krook, J.E., Novotny, P.J., Christensen, B. (2002). Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. Journal of Clinical Oncology, 20(2):567-573. Available from: .

[25]  Johansson, R., Kilkku, P., Groenroos, M. (1982). A double-blind, controlled trial of nabilone vs. prochlorperazine for refractory emesis induced by cancer chemotherapy. Cancer Treat Rev., 9 Suppl B: 25-33. Available from: .

[26]  Johnson, J.R., Burnell-Nugent, M., Lossignol, D., Ganae-Motan, E.D., Potts, R., Fallon, M.T. (2010). Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC: CBD Extract and THC Extract in Patients With Intractable Cancer-Related Pain. J Pain Symptom Manage, 39(2):167-79. Available from: .

[27]  Johnson, J.R., Lossignol, D., Burnell-Nugent, M., Fallon, M.T. (2013). An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. J Pain Symptom Manage, 46(2):207-18. doi: http://10.1016/j. [PubMed PMID: 23141881].

[28]  Jones, S.E., Durant, J.R., Greco, F.A., Robertone, A. (1982). A multi-institutional Phase III study of nabilone vs. placebo in chemotherapy-induced nausea and vomiting. Cancer Treat Rev., 9 Suppl B: 45-8. Available from: .

[29]  Lane, M., Vogel, C.L., Ferguson, J., Krasnow, S., Saiers, J.L., Hamm, J. (1991). Dronabinol and prochlorperazine in combination for treatment of cancer chemotherapy-induced nausea and vomiting. Journal of Pain and Symptom Management,6:352-359. Available from: .

[30]  Levitt, M., Faiman, C., Hawks, R., Wilson, A. (1984). Randomized double blind comparison of delta-9-tetrahydroicannabinol (THC) and marijuana as chemotherapy antiemetics. Proceedings of the American Society for Clinical Oncology,3:91. Available from: .

[31]  Lynch, M.E., Cesar-Rittenberg, P., Hohmann, A.G. (2014). A double-blind, placebo-controlled, crossover pilot trial with extension using an oral mucosal cannabinoid extract for treatment of chemotherapy-induced neuropathic pain. J Pain Symptom Manage, 47(1):166-73. doi: http://10.1016/j. [PubMed PMID: 23742737].

[32]  Madras, B.K. (2015). Update of Cannabis and its medical use. 37th ECDD (2015) Agenda item 6.2, available from: .

[33]  Maida, V., Ennis, M., Irani, S., Corbo, M., Dolzhykov, M. (2008). Adjunctive nabilone in cancer pain and symptom management: a prospective observational study using propensity scoring. J Support Oncol., 6(3):119-24. Available from: .

[34]  Maida, V. (2008). Nabilone for the treatment of paraneoplastic night sweats: a report of four cases. J Palliat Med., 11(6):929-34. Available from: .

[35]  Maida, V. (2006). The synthetic cannabinoid nabilone improves pain and symptom management in cancer patients. Abstract presented at the San Antonio Breast Cancer Symposium on 15 December 2006, Available from: .

[36]  McCabe, M., Smith, F.P., Goldberg, D., Macdonald, J., Woolley, P.V., Warren, R. (1988). Efficacy of tetrahydrocannabinol in patients refractory to standard anti-emetic therapy. Investigational New Drugs, 6:243-246. Available from: .

[37]  Meiri, E., Jhangiani, H., Vredenburgh, J.J., Barbato, L.M., Carter, F.J., Yang, H.M., Baranowski, V. (2007). Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Curr Med Res Opin, 23(3):533-43. Available from: .

[38]  Musty, R.E., Rossi, R. (2001). Effects of smoked cannabis and oral delta-9-tetrahydrocannabinol on nausea and emesis after cancer chemotherapy: A review of state clinical trials. J Cannabis Ther, 1(1):29-42. Available from: .

[39]  Neidhart, J.A., Gagen, M.M., Wilson, H.E., Young, D.C. (1981). Comparative trial of the antiemetic effects of THC and haloperidol. International Journal of Clinical Pharmacology Research, 21: 38-42S. Available from: .

[40]  Nelson, K., Walsh, D., Deeter, P., Sheehan, F. (1994). A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer-associated anorexia. Journal of Palliative Care, 10(1):14-18. Available from: .

[41]  Niederle, N., Schutte, J., Schmidt, C.G. (1986). Crossover comparison of the antiemetic efficacy of nabilone and alizapride in patients with nonseminomatous testicular cancer receiving cisplatin therapy. Klin Wochenschr, 64(8):362-5. Available from: .

[42]  Niiranen, A., Mattson, K. (1985). A cross-over comparison of nabilone and prochlorperazine for emesis induced by cancer chemotherapy. Amerícan Journal of Clinical Oncology, 8(4):336-40. Available from: .

[43]  Noyes, R. Jr, Brunk, S.F., Avery, D.A.H., Canter, A. C. (1975). The analgesic properties of delta-9-tetrahydrocannabinol and codeine. Clinical Pharmacology and Therapeutics, 18(1):84-89. Available from: .

[44]  Noyes, R. Jr, Brunk, S.F., Baram, D.A., Canter, A. (1975). Analgesic effect of delta-9-tetrahydrocannabinol. Journal of Clinical Pharmacology, 15(2-3):139-143. Available from: .

[45]  Orr, L.E., McKernan, J.F., Bloome, B. (1980). Antiemetic effect of tetrahydrocannabinol. Compared with placebo and prochlorperazine in chemotherapy-associated nausea and emesis. Annals of Internal Medicine, 140(11):1431-1433. Available from: .

[46]  Pomeroy, M., Fennelly, J.J., Towers, M. (1986). Prospective randomized double-blind trial of nabilone versus domperidone in the treatment of cytotoxic-induced emesis. Cancer Chemother Pharmacol, 17(3):285-8. Available from: .

[47]  Portenoy, R.K., Ganae-Motan, E.D., Allende, S., Yanagihara, R., Shaiova, L., Weinstein, S., McQuade, R., Wright, S., Fallon, M.T. (2012). Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain, 13(5):438-49. Available from: .

[48]  Priestman, T.J., Priestman, S.G. (1984). An initial evaluation of Nabilone in the control of radiotherapy-induced nausea and vomiting. Clin Radiol., 35(4):265-6. Available from: .

[49]  Sallan, S.E., Cronin, C., Zelen, M., Zinberg, N.E. (1980). Antiemetics in patients receiving chemotherapy for cancer: a randomized comparison of delta-9-tetrahydrocannabinol and prochlorperazine. New England Journal of Medicine, 302(3):135-138. Available from: .

[50]  Sallan, S.E., Zinberg, N.E., Frei, E. (1975). Antiemetic effect of delta-9-tetrahydrocannabinol in patients receiving cancer chemotherapy. New England Journal of Medicine, 293(16):795-797. Available from: .

[51]  Steele, N., Gralla, R.J., Braun, D.W. Jr, Young, C.W. (1980). Double-blind comparison of the antiemetic effects of nabilone and prochlorperazine on chemotherapy-induced emesis. Cancer Treatment Report, 64(2-3):219-24. Available from: .

[52]  Strasser, F., Luftner, D., Possinger, K., Ernst, G., Ruhstaller, T., Meissner, W., Ko, Y.D., Schnelle, M., Reif, M., Cerny, T. (2006). Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-in-Cachexia-Study-Group. J Clin Oncol, 24(21):3394-400. Available from: .

[53]  Ungerleider, J.T., Andrysiak, T., Fairbanks, L., Goodnight, J., Sarna, G., Jamison, K. (1982). Cannabis and cancer chemotherapy: a comparison of oral delta-9-THC and prochlorperazine. Cancer, 50:636-645. Available from: .

[54]  Ungerleider JT, Sarna G, Fairbanks LA, Goodnight J, Andrysiak T, Jamison K. (1985). THC or Compazine for the cancer chemotherapy patient--the UCLA study. Part II: Patient drug preference. American Journal of Clinical Oncology, 8: 142-147. Available from: .

[55]  Vinciguerra, V., Moore, T., Brennan E. (1988). Inhalation marijuana as an antiemetic for cancer chemotherapy. New York State Journal of Medicine, 88:525-527. Available from: .

[56]  Wadleigh, R., Spaulding, G.M., Lumbersky, B., Zimmer, M., Shepard, K., Plasse, T. (1990). Dronabinol enhancement of appetite in cancer patients. Proc Am Soc Oncology, 9: 331. Available from: .

[57]  Waissengrin, B., Urban, D., Leshem, Y., Garty, M., Wolf, I. (2015). Patterns of use of medical cannabis among Israeli cancer patients: a single institution experience. J Pain Symptom Manage, 49(2):223-30. doi: http://10.1016/j. [PubMed PMID: 24937161].

[58]  Zutt, M., Hanssle, H., Emmert, S., Neumann, C., Kretschmer, L. (2006). Dronabinol for supportive therapy in patients with malignant melanoma and liver metastases. Hautarzt, 57(5):423-7. Available from: .