大麻素:治疗慢性和化疗诱导性神经病理性疼痛的当前和未来选择。
Cannabinoids: Current and Future Options to Treat Chronic and Chemotherapy-Induced Neuropathic Pain.
机构信息
Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA.
Department of Anesthesiology and Department of Pharmacology, Penn State University College of Medicine, Hershey, PA, 17033, USA.
出版信息
Drugs. 2019 Jun;79(9):969-995. doi: 10.1007/s40265-019-01132-x.
Increases in cancer diagnosis have tremendous negative impacts on patients and their families, and major societal and economic costs. The beneficial effect of chemotherapeutic agents on tumor suppression comes with major unwanted side effects such as weight and hair loss, nausea and vomiting, and neuropathic pain. Chemotherapy-induced peripheral neuropathy (CIPN), which can include both painful and non-painful symptoms, can persist 6 months or longer after the patient's last chemotherapeutic treatment. These peripheral sensory and motor deficits are poorly treated by our current analgesics with limited effectiveness. Therefore, the development of novel treatment strategies is an important preclinical research focus and an urgent need for patients. Approaches to prevent CIPN have yielded disappointing results since these compounds may interfere with the anti-tumor properties of chemotherapeutic agents. Nevertheless, the first (serotonin noradrenaline reuptake inhibitors [SNRIs], anticonvulsants, tricyclic antidepressants) and second (5% lidocaine patches, 8% capsaicin patches and weak opioids such as tramadol) lines of treatment for CIPN have shown some efficacy. The clinical challenge of CIPN management in cancer patients and the need to target novel therapies with long-term efficacy in alleviating CIPN are an ongoing focus of research. The endogenous cannabinoid system has shown great promise and efficacy in alleviating CIPN in preclinical and clinical studies. In this review, we will discuss the mechanisms through which the platinum, taxane, and vinca alkaloid classes of chemotherapeutics may produce CIPN and the potential therapeutic effect of drugs targeting the endocannabinoid system in preclinical and clinical studies, in addition to cannabinoid compounds diffuse mechanisms of action in alleviation of CIPN.
癌症诊断的增加对患者及其家庭以及社会和经济成本都有巨大的负面影响。化疗药物对肿瘤抑制的有益作用伴随着许多不必要的副作用,如体重减轻和脱发、恶心和呕吐以及神经病理性疼痛。化疗引起的周围神经病变(CIPN),包括疼痛和非疼痛症状,在患者最后一次化疗治疗后 6 个月或更长时间仍可能持续存在。这些周围感觉和运动功能障碍用我们目前的镇痛剂治疗效果有限,效果不佳。因此,开发新的治疗策略是一个重要的临床前研究重点,也是患者的迫切需要。预防 CIPN 的方法收效甚微,因为这些化合物可能会干扰化疗药物的抗肿瘤特性。尽管如此,CIPN 的一线(5-羟色胺去甲肾上腺素再摄取抑制剂 [SNRIs]、抗惊厥药、三环类抗抑郁药)和二线(5%利多卡因贴剂、8%辣椒素贴剂和弱阿片类药物如曲马多)治疗方法已显示出一定的疗效。癌症患者 CIPN 管理的临床挑战以及需要针对具有长期疗效的新型疗法来缓解 CIPN 是研究的持续重点。内源性大麻素系统在缓解 CIPN 的临床前和临床研究中显示出巨大的潜力和疗效。在这篇综述中,我们将讨论铂类、紫杉烷类和长春花生物碱类化疗药物产生 CIPN 的机制,以及靶向内源性大麻素系统的药物在临床前和临床研究中的潜在治疗效果,此外还讨论了大麻素化合物在缓解 CIPN 中的扩散作用机制。