Current guidelines as well as the FDA-approved indications consider dronabinol’s role to be in the management of breakthrough CINV. Dronabinol has a unique mechanism of action and adverse effect profile that should be considered when treating a patient with this medication. Unfortunately, there are few ongoing studies evaluating the role of dronabinol in the management of CINV. Two completed, yet unpublished, studies have evaluated dronabinol in combination with a 5-HT3 RA as a prophylactic strategy. At this time, there is insufficient data to support the routine use of dronabinol as an antiemetic in all chemotherapeutic regimens. Data do support the beneficial effects of dronabinol in the breakthrough CINV setting. Further study of the scope of dronabinol’s potential efficacy is warranted.
Megan Brafford May,1 Ashley E. Glode2
1Department of Pharmacy, Baptist Health Lexington, Lexington, KY, USA; 2Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
The authors report no conflicts of interest in this work.
1. Fernandez-Ortega P, Caloto MT, Chirveches E, et al. Chemotherapy-induced nausea and vomiting in clinical practice: impact on patient’s quality of life. Support Care Cancer. 2012;20:3141–3148.
2. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines)®: Antiemesis Version 2.2015. Fort Washington, PA: National Comprehensive Cancer Network; 2015.
3. Haiderali A, Menditto L, Good M, Teitelbaum A, Wegner J. Impact on daily functioning and indirect/direct costs associated with chemotherapy-induced nausea and vomiting (CINV) in a US population. Support Care Cancer.2011;19:843–851.
4. Natale J. Reviewing current and emerging antiemetics for chemotherapy-induced nausea and vomiting prophylaxis. Hosp Pract. 2015;43(4):226–234.
5. Pertwee RG. Emerging strategies for exploiting cannabinoid receptor agonists as medicines. Br J Pharmacol. 2009;156:397–411.
6. Slatkin NE. Cannabinoids in the treatment of chemotherapy-induced nausea and vomiting: beyond prevention of acute emesis. J Support Oncol. 2007;5(Suppl 3):1–9.
7. Marinol(R) [package insert]. High Point, NC: Unimed Pharmaceuticals, Inc; 2004.
8. Meiri E, Jhangiani H, Vredenburgh, et al. Efficacy of dronabinol alone and in combination with ondansetron versus ondansetrom alone for delayed chemotherapy-induced nausea and vomiting. Curr Med Res Opin. 2007;23(3):533–543.
9. Todaro B. Cannabinoids in the treatment of chemotherapy-induced nausea and vomiting. JNCCN. 2012;10(4):487–492.
10. Tramer MR, Carroll D, Campbell FA, Reynolds JM, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systemic review. BMJ. 2001;323:16–21.
11. Rocha FM, Stefano SC, De Cassia Haiek R, Oliveira LR, Silveira DD. Therapeutic use of Cannabis sativa on chemotherapy-induced nausea and vomiting among cancer patients: systematic review and meta-analysis. Eur J Cancer Care. 2008;17:431–443.
12. Lane M, Vogel CL, Ferguson J, et al. Dronabinol and prochlorperazine in combination for treatment of cancer chemotherapy-induced nausea and vomiting. J Pain Symptom Manage. 1991;6(6):352–359.
13. Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems. A clinical review. JAMA. 2015;313(24):2474–2483.
14. Seamon MJ, Fass JA, Maniscalco-Feichtl M, Abu-Shraie NA. Medical marijuana and the developing role of the pharmacist. Am J Health Syst Pharm. 2007;64:1037–1044.
15. Chang AE, Shiling DJ, Stillman RC, et al. Delta-9-tetrahydrocannabinol as an antiemetic in cancer patients receiving high-dose methotrexate. A prospective, randomized evaluation. Ann Intern Med. 1979;91:819–824.
16. Chang AE, Shiling DJ, Stillman RC, et al. A prospective evaluation of delta-9-tetrahydrocannabinol as an antiemetic in patients receiving adriamycin and cytoxan chemotherapy. Cancer. 1981;47:1746–1751.
17. Musty RE, Rossi, R. Effects of smoked cannabis and oral Δ9-trahydrocannabinol on nausea and emesis after cancer chemotherapy: A review of state clinical trials. J Cannabis Therapeutics. 2001;1(1):29–56.
18. Solvay Pharmaceuticals. Dronabinol versus standard ondansetron antiemetic therapy in preventing delayed-onset chemotherapy-induced nausea and vomiting. NLM identifier: NCT00642512. Available from: https://clinicaltrials.gov/ct2/show/NCT00642512. Accessed April 13, 2016.
19. National Cancer Institute and Solvay Pharmaceuticals; M.D. Anderson Cancer Center. Palonosetron and dexamethasone with or without dronabinol in preventing nausea and vomiting in patients receiving chemotherapy for cancer. NLM Identifier: NCT00553059. Available from: https://clinicaltrials.gov/ct2/show/NCT00553059 . Accessed April 13, 2016.
20. Solvay Pharmaceuticals; Duke University. A pilot study of dronabinol for adult patients with primary gliomas. NLM Identifier: NCT00314808. Available from: http://clinicaltrials.gov/show/NCT00314808. Accessed April 13, 2016.
Source: Cancer Management and Research
Originally published May 12, 2016.