Tuesday, 10 October 2017

Immunotherapy and cannabis

Hi,

Does anyone have information on concurrent use of immunotherapy and cannabis? I read that cannabis can have anti-inflammatory effects primarily due to it suppressing the immune system. This seems worrisome if the patient is on immunotherapy. All I could find is one retrospective study on cannabis and opdivo use: http://oncologypro.esmo.org/Meeting-Resources/ESMO-2017-Congress/The-effect-of-cannabis-use-on-tumor-response-to-Nivolumab-in-patients-with-advanced-malignancies

 Has anyone's doctor mentioned a possible contraindication?

Thank you.
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11 comments:

  1. Stephen W11 October 2017 at 05:01

    This study you've linked to is the only human study I've ever seen looking at the effect of cannabis use during cancer immunotherapy. I've long said that I would probably avoid cannabis use during immunotherapy due to the potential for immunosuppression. On the other hand we have clinical evidence of improved survival with cannabinoid use (Sativex) combined with TMZ for recurrent GBM.

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    1. Unknown15 October 2018 at 10:21

      Using cannabis oil would be superior to using Sativex or immunotherapy. Cannabis is a unique plant with a ridiculous amount of healing compounds. Taking only one of those compounds and synthesizing it in to a drug such as Sativex or Marinol is nowhere as effective.

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  2. SVG12 October 2017 at 04:56

    It is not that simple ! First of all, there is the endogeneous opioid system mechanism present in everybody, besides the pharmacologic dosing from outside. Second, this opioid system is connected to a broader axis called psychoneuroendocrine regulation. Third, most of the papers do not distinct inflammation from immunization. Although looked isolated, CBD and others are anti-inflammatory and maybe block intracellular signals in immune cells as well. But looking to the broader picture might give a more global picture. I refer in particular to two publications in 2017 on this issue.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426095/?report=printable
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5258717/pdf/fnmol-10-00014.pdf

    I hope this helps a bit.

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    1. Stephen W12 October 2017 at 05:31

      Also the endogenous cannabinoid system, in addition to the endogenous opioid system.

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  3. Stephen W12 October 2017 at 05:59

    THC:

    Δ9-tetrahydrocannabinol impairs the inflammatory response to influenza infection: role of antigen-presenting cells and the cannabinoid receptors 1 and 2.
    https://www.ncbi.nlm.nih.gov/pubmed/23152191

    Δ-9-Tetrahydrocannabinol inhibits antitumor immunity by a CB2 receptor-mediated, cytokine-dependent pathway.
    https://www.ncbi.nlm.nih.gov/pubmed/10861074

    Δ9-Tetrahydrocannabinol attenuates allogeneic host-versus-graft response and delays skin graft rejection through activation of cannabinoid receptor 1 and induction of myeloid-derived suppressor cells
    http://www.jleukbio.org/content/98/3/435.abstract

    We can't expect that pure THC would have the same effects as plant-based cannabis products, or products high in CBD rather than THC. The ESMO abstract doesn't tell us anything more detailed about what these patients were taking than the generic term "cannabis". Yet given the weight of the (mostly preclinical) evidence is showing immunosuppressive effects of THC, I would be hesitant to combine it with active immunotherapy strategies.

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    1. SVG12 October 2017 at 09:49

      Thank you Stephen for this additional information and publications. It is a great honor to me to have this conversation with you.

      The three publications point to studies in mice. The first clearly points to the role of the inflammatory component which they call "myeloid cell immune function". The last one points to the functioning of myeloid derived suppressor cells in a GVHD model (we target in the immunotherapy those cells with ATRA, as you know). The second publication illustrates stronger your concern of blocking adaptive immune response at the mouse T cell level. Still the two 2017 publications that I mention might give also a bit light, and are "from the human side". Whatsoever it remains certainly not that simple - as I wrote. It should be clearly discussed with each patient independently. On top of that, with immune functional tests one can eventually monitor the immune reactivity before and after start of CBD in the context of active specific immunotherapy.

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    2. Stephen W12 October 2017 at 20:24

      Thanks, I appreciate your balanced view and the expertise you bring to these questions.

      I agree on the "not so simple". Nothing is ever simple in cell biology it seems. I'll try to look read the two studies that you linked more carefully. Still, personally I think I would need to see some evidence for non-interference of THC/CBD with immunotherapy before I would be comfortable with such a combination. It would be relatively straighforward to do an in vivo study with vaccine alone, and vaccine + cannabinoids. And certainly one could monitor the immune reactivity in cancer patients before and after cannabinoids as you suggest.

      Altogether more study is needed, but the retrospective study (ESMO abstract) mentioned in the original post of this thread adds weight to my concerns.

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    3. Unknown31 October 2017 at 18:37

      Hi Stephen and SVG,

      This is a very interesting discussion, thank you both!

      I just wanted to note that my Mum is undergoing immunotherapy treatment and continues to use CBD and THC alongside this. She has been taking about 100mg CBD/day(ACDC oil) and 6mg THC (Sherbert) as recommended by Aunt Zeldas. She has been doing so for almost two years now. Aunt Zeldas are cautious of recommending high doses and always say 'less is more' at a certain point, perhaps for this reason?
      Mum continues to have treatment at the IOZK at 8 week intervals. This dose seems to work well for my Mum. Its anecdotal evidence but I thought it would be useful to document here!

      Her latest scan shows again a reduction in 'the nodular component' around the resection cavity and a nodule that appeared in October 2016 has not been seen since.

      I might also take this opportunity to highly recommend the IOZK if it is an option to someone fighting this awful disease.

      Thanks again for the info above.

      Alison

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    4. Stephen W31 October 2017 at 21:35

      Thanks for the update Alison, so glad to hear your mom is still doing well!

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  4. Unknown18 November 2018 at 15:58

    Hi i have searched the internet high and low for anyone using the combination of emunatherapy aswell as Htc oil ,My husband was diagnosed with renal cell carcoma a few weeks ago and given a prognosis of roughly around two years ,We were in despair Horrified and scared !He stareted emuanatherapy and switched to a plant based diet During our research we read lots of stories about Htc and found someone who was growing it for his mum who was fighting a tumour in her brain , He is now taking both ,and is going to continue to do so until hes first three month scan ,Its too scarey to give up on the emunatherapy as we are told it will prolong hes life and may shrink the tumour but The amazing stories and research we have done on HTC makes it almost impossible not to give it a go ,Having said that we still worry incase the two do counteract eachother ,would be so happy to talk to someone who has actualy done both and is doing ok ,Thank u in advance to anyone who replies Toni x

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  5. Robin16 December 2018 at 02:47

    Please anyone can tell me if immunotherapy and thx oil use has resulted anything good or not? There is only one real human research and I don't want my dad give up on thc oil that just started with opdivo immunotherapy srug. If anyone has experience please share with me

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