背景:临床前研究已经证明了大麻素的潜在抗癌活性,然而,很少有临床数据支持这一点。近40%的使用大麻的癌症患者相信,它将通过社交媒体平台在线分享大量的轶事报道来治疗他们的癌症。病例报告已发表在同行评审的期刊上,但往往缺乏关键的临床信息来验证抗癌的主张。方法:我们回顾了PubMed和EBSCO数据库中评估大麻或内源性大麻素系统与潜在抗癌活性之间关系的文献。我们还审查了在线资源,书籍,和ClinicalTrials.gov有关使用大麻作为癌症治疗的报告或研究。所有发表在同行评审期刊上的病例报告都被汇编和评估为薄弱的,中度,或者基于提供的支持抗癌作用的证据的质量。强有力的报告符合三个标准;(a)服用大麻时癌症活跃,(b)报告了经过验证的实验室或射线照相响应,和(c)未同时进行抗癌治疗的大麻。结果:在回顾的207篇临床前文章中,107(52%)是具有原始数据的临床前研究。共有77份独特的病例报告描述了患有各种癌症的患者(乳腺癌,中枢神经系统,妇科,白血病,肺,前列腺,和胰腺)使用大麻。我们的评估显示,14%的病例报告被认为是强有力的,5%适度,剩下的81%都很弱。10%的病例是儿科患者。大麻二酚的使用最常被报道为抗癌大麻素,每日剂量为10至800mg。六项研究报告了四氢大麻酚的使用,剂量范围为4.8至7.5毫克。两项小型试验发表了多形性胶质母细胞瘤复发患者生存数据。结论:对临床数据的回顾表明,大多数已发表的,同行评审的病例报告提供的数据不足以支持大麻作为抗癌剂的主张,并且不应该被用来代替基于证据的,临床试验之外的传统治疗方法。没有强有力的临床试验数据来证实表明大麻素可能具有抗癌益处的临床前研究。需要进一步研究探索大麻在对传统疗法没有反应的转移性癌症患者中的抗癌潜力。
Background: Pre-clinical studies have demonstrated the potential anticancer activity of cannabinoids, yet little clinical data exist to support this. Nearly 40% of patients with cancer using cannabis believe it will treat their cancer with numerous anecdotal reports shared online through social media platforms.
Case reports have been published in peer-reviewed journals, but often lack key clinical information to validate anticancer claims. Methods: We reviewed literature in PubMed and EBSCO databases that evaluated the relationship between cannabis or the endocannabinoid system and potential anticancer activity. We also reviewed online sources, books, and ClinicalTrials.gov for reports or studies on using cannabis as cancer treatment. All
case reports published in peer-reviewed journals were compiled and appraised as weak, moderate, or strong based on the quality of evidence provided supporting an anticancer effect. Strong reports met three criteria; (a) active cancer at time of cannabis administration, (b) validated laboratory or radiographic responses were reported, and (c) cannabis used without concurrent anticancer treatments. Results: Of the 207 pre-clinical articles reviewed, 107 (52%) were pre-clinical studies with original data. A total of 77 unique
case reports described patients with various cancers (breast, central nervous system, gynecological, leukemia, lung, prostate, and pancreatic) using cannabis. Our appraisal showed 14% of the
case reports were considered strong, 5% moderate, and the remaining 81% were weak. Ten percent of cases were in pediatric patients. Cannabidiol use was most often reported as the anticancer cannabinoid with daily doses ranging from 10 to 800 mg. Tetrahydrocannabinol use was reported in six studies, with doses ranging from 4.8 to 7.5 mg. Two small trials published data on survival in patients with recurrent glioblastoma multiforme. Conclusion: This review of clinical data suggests most published, peer-reviewed
case reports provide insufficient data to support the claim for cannabis as an anticancer agent, and should not be used in place of evidence-based, traditional treatments outside of a clinical trial. No strong clinical trial data exist to confirm the pre-clinical studies that suggest cannabinoids may have an anticancer benefit. Future studies exploring anticancer potential of cannabis in patients with metastatic cancers who have not responded to traditional therapy are needed.