Likar Rudolf, Nahler Gerhard
Abteilung für Anästhesiologie und Intensivmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020 Klagenfurt am Wörthersee (R.L.); CIS Clinical Investigation Support GmbH, Kaiserstrasse 43, 1070 Wien (G.N.).
Neurooncol Pract. 2017 Sep;4(3):151-160. doi: 10.1093/nop/npw027. Epub 2017 Jan 18.
Cannabinoids are multitarget substances. Currently available are dronabinol (synthetic delta-9-tetrahydrocannabinol, THC), synthetic cannabidiol (CBD) the respective substances isolated and purified from cannabis, a refined extract, nabiximols (THC:CBD = 1.08:1.00); and nabilone, which is also synthetic and has properties that are very similar to those of THC. Cannabinoids have a role in the treatment of cancer as palliative interventions against nausea, vomiting, pain, anxiety, and sleep disturbances. THC and nabilone are also used for anorexia and weight loss, whereas CBD has no orexigenic effect. The psychotropic effects of THC and nabilone, although often undesirable, can improve mood when administered in low doses. CBD has no psychotropic effects; it is anxiolytic and antidepressive. Of particular interest are glioma studies in animals where relatively high doses of CBD and THC demonstrated significant regression of tumor volumes (approximately 50% to 95% and even complete eradication in rare cases). Concomitant treatment with X-rays or temozolomide enhanced activity further. Similarly, a combination of THC with CBD showed synergistic effects. Although many questions, such as on optimized treatment schedules, are still unresolved, today's scientific results suggest that cannabinoids could play an important role in palliative care of brain tumor patients.
大麻素是多靶点物质。目前可用的有屈大麻酚(合成的Δ9-四氢大麻酚,THC)、合成大麻二酚(CBD),它们分别是从大麻中分离和纯化出来的物质、一种精制提取物、纳布西莫尔(THC:CBD = 1.08:1.00);还有那比隆,它也是合成的,具有与THC非常相似的性质。大麻素在癌症治疗中可作为针对恶心、呕吐、疼痛、焦虑和睡眠障碍的姑息性干预措施。THC和那比隆也用于治疗厌食和体重减轻,而CBD没有促食欲作用。THC和那比隆的精神活性作用虽然通常不理想,但在低剂量给药时可改善情绪。CBD没有精神活性作用;它具有抗焦虑和抗抑郁作用。特别值得关注的是动物胶质瘤研究,其中相对高剂量的CBD和THC显示出肿瘤体积显著缩小(约50%至95%,在罕见情况下甚至完全消除)。与X射线或替莫唑胺联合治疗可进一步增强活性。同样,THC与CBD的组合显示出协同作用。尽管许多问题,如优化治疗方案等仍未解决,但当今的科学结果表明,大麻素可能在脑肿瘤患者的姑息治疗中发挥重要作用。