I've been wrestling with this for some time now so I thought I'd ask everyone's opinion on the matter.
I've been gradually increasing my wife's dosage of CO to 300mg a day, hoping to reach the magic 1gm a day that's been anecdotally espoused on various places online.
However, going through all the old CancerCompass posts, I'm wondering if it might be better to just do pure CBD oil. What is everyone's thoughts as to cannabis oil versus just pure CBD. And if we were to do pure CBD, how much should we be taking to combat a GBM?
Both are difficult to get where I am so I'm wondering which of the two I should be focusing on acquiring.
Our neuro-onc at UCLA recommended we speak to Dr. Frankel, a former UCLA internist who now specializes in medical cannabis. His recommendation for my husband was: "CBD-THC 1:1 as the primary medication is ideal. At that average amount of sprays, he should be getting around 33.8mg of CBD and 33.8mg of THC per day" Which for us translates to 5x a day, 3 sublingual sprays per time. I hope this helps.
ReplyDeleteHere is a siting that you might find helpful: http://mct.aacrjournals.org/content/10/1/90.full
DeleteVery interesting - so this report seems to say that both play a role (at least in vitro) versus GBM. But it seems to only say they have an effect while taking TMZ, and we just finished our SoC.
DeleteMy biggest concern with the THC comes from this report which says, "Taken together, our data show that concentrations of THC comparable with those detected in the serum of patients after THC administration accelerate proliferation of cancer cells instead of apoptosis and thereby contribute to cancer progression in patients.”
http://www.ncbi.nlm.nih.gov/pubmed/15026328
I'm interested in Stephen's view of this report - although I note that it doesn't talk about GBM and also my wife's particular strain of cancer doesn't seem to have significant EGFR activity.
I've seen this study before. They did test 100 nM and 300 nM concentrations of THC on the GBM cell line U373, which increased proliferation. While concentrations of THC >100 nM are achievable in plasma, most of this is bound to plasma proteins, leaving ~ 5 nM unbound, which is approximately the binding affinity of THC for the CB1 and CB2 receptors, at least according to one study.
Deletehttp://jpet.aspetjournals.org/content/296/2/420/T1.expansion.html
I have not seen any publication testing THC against cancer cells at concentrations as low as 5 nM, but I would expect very little activity would be seen.
Another unanswered question is how much THC would be found in the brain extracellular fluid.
There is surprisingly little high quality data on cannabinoids and cancer given how much talk there is about it. [In vitro studies using micromolar concentrations of THC or CBD do not count]
The above comment was not meant to imply that I believe cannabinoids are ineffective. There could very well be indirect mechanisms in vivo that we know nothing about. Hopefully ongoing trials will provide some needed information soon.
DeleteThere was at least one study showing that THC + CBD injected intraperitoneally into immunocompetent mice slowed the growth of the mouse gliomas, and was especially effective combined with radiation.
Deletehttp://www.ncbi.nlm.nih.gov/pubmed/25398831
Apart from anecdotal human evidence, this is the best evidence I've seen for CBD+THC as a glioma treatment.
Well, I suppose then my main question is, "Is the THC going to hurt her?" If *appears* (and tell me if I'm wrong) that 1gm of THC/CBD isn't going to make matters worse, despite the report I put up, because of how the researchers applied the THC, yes?
DeleteThanks again for the response - super helpful.
Logan - there is a facebook group specifically for glioblastoma and cannabis. https://www.facebook.com/groups/glioNOmore/
ReplyDeleteThe admins are very helpful and quick to reply. Might reach out to them with questions.
Thanks - I just joined!
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ReplyDeleteThe above two comments look very suspicious to me. The first one was copied and pasted multiple times on many different blogs. They are most likely spam.
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ReplyDeleteI just read some comments on the use of CBD / THC and understand that there is only limited evidence but might be effective used in combination during radiation. My question is, which dose (probably as a spray) might be sufficient. The supplements page indicates 10mg / day of each, the neuro-onc in the first comment recommended 34mg and Rick Simpson uses 1g. Any thoughts are welcome.
ReplyDeleteThe 10 mg per day of THC/CBD is not a recommendation for humans, but a conversion of the mouse dose used in the study to a human dose based on an allometric scaling formula. This method is inexact and furthermore the mice were injected with cannabinoids, rather than given them orally. 10 mg is most likely an underdosing, especially for CBD, where hundreds of mg is perfectly safe and tolerable.
ReplyDeleteThe 1 gram recommended by Rick Simpson refers to the total cannabis oil, rather than the THC/CBD content. 1 gram cannabis oil would contain less than 1 gram of cannabinoids, and that content would vary depending on the strain of cannabis used and the method of preparation. Also note that according to the Rick Simpson website it takes 3-5 weeks to build up tolerance to that amount of cannabis oil.
http://phoenixtears.ca/dosage-information/
The first clinical trial of systemic cannabinoids (in this case Sativex spray) for glioblastoma has been completed but not data reported yet.
https://clinicaltrials.gov/ct2/show/NCT01812603
The maximum dose used in this trial is similar to the dose recommended by Dr. Frankel as described in the first comment above.
In the trial, 12 sprays (100 uL per spray) was used as maximum dose, or 1.2 mL per day. Given a THC/CBD content of 27 and 25 mg/mL for Sativex, the total daily dose of THC and CBD would then be 32 mg of THC and 30 mg of CBD with this regimen.
As mentioned elsewhere, given the non-psychoactivity of CBD much higher doses of CBD are well tolerated.
So in summary there are two very different dosing regimens being recommended: a lower dose of spray in the neighborhood of 30-40 mg each of CBD and THC per day. And then a much higher dose given as cannabis oil, which at a dose of one gram daily would give 500 mg THC at a THC content of 50%.
DeleteOf course intermediate doses somewhere in between would also be an option.
Thanks for the prompt response. We think about adding CBD/THC just during radiation. Owing to the limited time span, we might go with Sativex despite the high price. So 32mg of THC should be fine. Will there be additional benefit from a higher dose of CBD or is 30mg sufficient?
ReplyDeleteI can't speak to the antitumor efficacy of CBD in humans, but there are people on this blog who've reported much improvement in symptoms and quality of life on daily CBD doses around 200 mg per day. Remember CBD also has anti-seizure and anti-inflammatory properties. A synthetic CBD preparation called "epidiolex" is being developed as a treatment for childhood epilepsy.
Deletehttp://www.gwpharm.com/epidiolex.aspx
Opt for the Rick Simpson Oil which has high THC and low CBD. The CBD is enough to stop the seizures and the THC is the real cancer killer. This is working well for my husband who has a stage 2 astrocytoma.
ReplyDeleteMy brother has grade 2 astrocytoma as well.is rick simpson oil killing the cabcer cells of your husbend brain tumor?how long have you been using the oil?how is it helping your husbend.i will be so thankfull if you answer me.thank you
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