Investigators have revealed that there may be a lack of evidence to inform the dosing, safety, and efficacy of cannabinoids for managing symptoms in pediatric patients with cancer, according to a recent systematic review and meta-analysis published by Chhabra et al in Cancer.
Background
Although therapeutics for pediatric patients with cancer have improved significantly—even resulting in cures for some patients—many patients still suffer from cancer- or treatment-related symptoms such as pain, anxiety, and weight loss. Over the past decade, cannabinoids—both synthetic cannabinoids and natural phytocannabinoids—have gained popularity among patients and their families for the management of such symptoms; however, pediatric oncologists are often cautious to authorize cannabinoids for their patients given the limited data regarding dosing, product selection, and safety monitoring.
Study Methods and Results
In the new analysis, the investigators identified 19 unique studies—including eight retrospective chart reviews, seven randomized controlled trials, two open-label studies, and two case reports—involving 1,927 pediatric patients with cancer in order to examine the potential benefits and harms of medical-grade cannabinoids, synthetic cannabinoids, and unspecified cannabis herbal extracts. They noted that the products were most commonly used to manage chemotherapy‐induced nausea and vomiting.
In the randomized controlled trials, the investigators found that the patients who used cannabinoids were more likely to experience drowsiness, dizziness, dry mouth, and feeling high—and were almost four times more likely to drop out of the study as a result of adverse events compared with those who received placebo. Across all of the studies included in the analysis, no serious cannabis‐related adverse events were reported.
The investigators emphasized that most of the studies did not adequately describe the types, dosing, frequencies, and routes of administration of cannabinoids. Additionally, the outcomes were mixed and were reported in different ways. Therefore, the investigators identified a need to develop new standards for reporting cannabinoid exposures, cannabis‐related effects, and patient outcomes.
Conclusions
“It was difficult to measure benefit across studies, given a range of different outcomes and study designs; however, in interventional studies with active control groups, cannabinoids performed better in managing nausea and vomiting. Data are lacking on cannabinoids’ effects on pain, mood, sleep, and health-related quality of life,” stressed senior study author Lauren E. Kelly, PhD, MSc, BMedSci, CCRP, Associate Professor of Pharmacology and Therapeutics in the Rady Faculty of Health Sciences at the University of Manitoba. “Given that some [pediatric patients] report benefits and some … experience adverse events, it is critical that more rigorous studies evaluating the effects of cannabinoids on [pediatric patients] with cancer are conducted and shared with parents, patients, and the health-care community,” she concluded.
The new analysis informed the design of a new three-arm tolerability trial, which will begin recruiting 60 patients in the winter of 2023.
Disclosure: The research in this study was funded in part by the Canadian Cancer Society and Canadian Institutes of Health Research through a Cannabis Team Grant. For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
