What have we got to lose...quite possibly our lives?

In this blog, I’d like to assess the logic behind promoting the use of medical marijuana to treat and possibly prevent breast cancer, and the reason why medical research using cannabinoids should expand. This blog is my personal opinion and not necessarily that of the Cherry Blossom Breast Cancer Foundation, whose Directors and Officers may or may not agree with me.

I will avoid discussions regarding the legality/illegality of the use of medical marijuana. Either the Federal Government will decide for the entire country or each state will decide for itself. Matt Ferner in an article in the Huffington Post, August 2014, states that “eleven states have legalized CBD (cannabinoid) for medical use and research, plus 23 others have more broadly legalized marijuana for medical purposes. “ According to Joycelyn Elders, MD, former US Surgeon General “The evidence is overwhelming that medical marijuana can relieve certain types of pain, nausea, vomiting and other symptoms caused by such illnesses as multiple sclerosis, cancer and AIDS – or by the harsh drugs sometimes used to treat them. And it can do so with remarkable safety. Indeed, marijuana is less toxic than many of the drugs that physicians prescribe every day.”

Cannabis sativa or marijuana has been used as a medicine for nearly 5,000 years. Its recorded use in Indian and Chinese texts goes back well over 3,000 years. Marijuana has been used to beat beriberi, malaria, rheumatism, depression, muscle and joint pain, angina, epilepsy, muscle spasms, and a host of other ailments. Yet the modern day clinical use of plant derived preparations or pure cannabinoids, is very limited.

Cannabinoids are a complex family of chemicals that lock on to cannabinoid receptors - protein molecules on the surface of cells – within the body. Humans have two main types of cannabinoid receptors, CB1 and CB2. Both are found in different locations of the body and do different things. CB1 is found mainly in the nervous system, and CB2 is found in the immune system. There is also a family of receptors known as GPR (gene protein receptor) that are indicated in cancer research of which the main type is GPR55. Additionally, the human body also produces cannabinoid-like chemicals called endocannabinoids that form the endocannabinoid system, which affects relaxation, eating, sleeping, as well as some reactions.

It’s no secret among the research community that marijuana can block cancerous cell growth by preventing the growth of blood vessels that supply tumors, by causing cancerous cell death, and blocking cancerous cell growth. Most of the scientific research has been done using cancer cells grown in the lab or using animals. However, in the last few years, there has been an increase in the number of human studies. According to what I’ve read, the best results so far seem come from using a combination of highly purified THC and CBD (a cannabinoid found in cannabis plants that counteracts the psychoactive effects of THC). In his article, Matt Ferner states “A growing body of research suggests CBD may also be effective in reducing inflammation brought on by multiple sclerosis, stopping metastasis in many kinds of aggressive cancer, killing cancerous cells found in people with leukemia and serving as an alternative antipsychotic treatment.”

In laboratory studies, Delta-9-THC (the active ingredient in marijuana) has been shown to damage or kill liver cancer cells, lung cancer cells, and breast cancer cells. In fact, a laboratory study of CBD in estrogen receptor positive and estrogen receptor negative breast cancer cells showed that it caused cancer cell death while having little effect on normal breast cells. The article: Caffarel MM et al.Cannabinoids: A new hope for breast cancer therapy? Cancer Treat Rev (2012) summarizes that “our current knowledge on the anti-tumor potential of cannabinoids in breast cancer, suggests that cannabinoid-based medicines may be useful for the treatment of most breast tumor subtypes.”

In addition to tumor reduction, the NCI says that “Delta-9-THC has been proven to reduce cancer pain, nausea, anxiety and distress when compared with no treatment.” Yet the USFDA has not approved cannabis or cannabinoids for use as cancer treatment. You must ask yourself why, when the government allows the sale of highly treated, strain modified, lung, throat, neck, and mouth cancer causing tobacco for everyday use.

According to the NIH, two cannabinoids dronabinol (Marinol) and nabilone (Cesamet) both of which use synthetic Delta-9-THC have been “approved by the FDA for the treatment of chemotherapy-related nausea and vomiting in patients who have not responded to standard therapy.” Marinol is used as an appetite stimulant for AIDS patients and to ease neuropathic pain of multiple sclerosis. Sativex (derived from natural extracts), released in the UK in 2010 was the first cannabis-based prescription medicine. It is approved for use in several European Countries, Canada and New Zealand for relief of spasticity associated to multiple sclerosis, in Canada for the treatment of neuropathic pain in the same disease, and in 12 countries for the treatment of cancer-associated pain. In the context of cancer, it is well established that cannabinoids have antiemetic properties, and in fact, Marinol and Cesamet can be prescribed to prevent nausea and vomiting elicited by standard chemotherapeutic regimes.

Caffarel MM et al. stated in their study that “A general feature of cannabinoid anti-tumor action in breast and other types of tumors is the lack of toxicity on non-tumor cells… An additional characteristic of cannabinoids, which may have important clinical implications, is their safety. Cannabinoid-based medicines have been proven very safe in thousands of patients enrolled in multiple clinical trials in the last years and in cancer patients that use them for the management of pain, nausea, and vomiting.”

The paper discusses uses in the treatment of hormone sensitive breast cancer and HER2-positive breast cancer. It also covers the subject of cannabinoids and triple-negative breast cancer, for which there is no current treatment. Those patients, “whose prognosis is very poor as a group” are most often treated with chemotherapy.

The study concludes with the analysis that “There is compelling evidence showing that cannabinoids have anti-tumor activity in preclinical models of breast cancer. The data come not only from cell culture systems but also from more complex and clinically relevant animal models. This anti-tumor action is produced by the blockade of several hallmarks of cancer rather than by the targeting of a unique process, and the compounds are not only effective but safe.”

As for chemotherapy, the following table was extracted from a pooled analysis of 60 randomized clinical trials with a total of 28,764 women analyzed by age and survival rates by the Susan G. Komen Society, updated as of 2014. It shows the percent surviving adjuvant chemotherapy (after surgery), percent surviving without chemotherapy, and absolute improvement in the number of people surviving with chemotherapy when breast cancer is caught early and followed over a 15 year timeframe indicated low improvement rates:

Early Breast Cancer Trialists' Collaborative Group - Pooled Analysis

  15-Year Overall Survival
Age and Prognosis Percent Surviving -  Chemotherapy Percent Surviving - No chemotherapy Absolute Improvement in Survival with Chemotherapy
By age at diagnosis
<40 years 70% 64% 6%
40-49 76% 69% 7%
50-59 70% 66% 4%
60-69 69% 66% 3%
70 years or older 74% 68% 6%
Among women <50 at diagnosis
Lymph node negative 84% 79% 5%
Lymph node positive 55% 46% 9%
Among women 50-59 at diagnosis
Lymph node negative 86% 83% 3%
Lymph node positive 62% 59% 3%

 According to Julie Gralow, MD, Director of Breast Medical Oncology at Seattle Cancer Care Alliance, “chemotherapy is the most toxic of all the therapies.” It comes with a huge list of side effects. I have seen friends and family members opt for chemotherapy that made the end of their lives extremely painful and very miserable. Ultimately you must question the effectiveness of chemotherapy for certain breast cancers and wonder, how taking cannabinoids could possibly cause greater harm than chemotherapy – which has, depending upon the study you reference, a dismal “success” rate of between 1 – 3%, or as in the previous table 3% - 9%.

A new study from the University of East Anglia, UK released in the Journal of Biological Chemistry, discovered the exact compounds in marijuana that slow tumor growth. Earlier studies found that THC is responsible for slowing tumor growth. In 2007, two scientists, Dr. Pierre Desprez and Dr. Sean McAllister, at California Pacific Medical Center in San Francisco “found that a marijuana compound could stop metastasis in many kinds of aggressive cancer, potentially altering the fatality of the disease forever.” Their original research was on breast cancer, but “now we’ve found that cannabidiol works with many kinds of aggressive cancers, any kind in which high levels of ID-1 are present.” ID-1 is the gene that causes cancer to spread. Dr. McAllister’s research has already shown that CBD can reduce the spread of cancer to other parts of the body and they are in the process of initiating clinical trials. Additional studies on breast cancer, such as the one from the University of East Anglia, found that THC activated the CB2 receptors.

The recently published study found similar results on slowing tumor growth. Dr. Peter McCormick, researcher from the University of East Anglia’s school of pharmacy and co-author of the new study Targeting CB2-GPR55 Receptor Meteromers Modulates Cancer Cell Signaling 2014, said in a statement, “This compound (THC) is known to act through a specific family of cell receptors called cannabinoid receptors. However, it was unclear which of these receptors were responsible for the anti-tumor effects of THC.” He goes on to say, “Our findings help explain some of the well-known but still poorly understood effects of THC at low and high doses on tumor growth. So, the ideal would be either the purified THC in an effective dose provided by a health care provider to reduce the known cognitive side effects and still deliver the appropriate reduction in tumor growth, or a synthetic homolog that provides the same effects.” This isn’t the first time scientists have found that marijuana can be effective in fighting cancer. “Previous studies have found that THC cuts tumor growth in lung cancer in half and also prohibited the cancer from spreading. THC has also been shown to induce death in brain cancer cells.”

In a 12/1/13 article by Lara Stielow entitled Breast Cancer Patients Helped With Marijuana – “Breast cancer patients can be helped by marijuana if they merely want to have it as an adjunct to more standard Western medical practices. A patient does not smoke or eat marijuana, nor do they exhibit a sense or euphoria, time distortion or short-term memory loss from cannabinoids uses to combat cancer. In order for the anticancer effects to be optimized, highly concentrated extracts are put into capsules and administered to patients.”

Apparently human studies are underway but treatments have not been approved by the FDA. She goes on to say. “The production of these medications is much cheaper than standard current therapies and they also do not require ongoing intensive monitoring by healthcare professionals. A patient can safely self-administer a cannabinoid medication at home, as it has extremely low toxicity and has virtually no associated side effects….A breast cancer patient can be helped with marijuana to beat the illness while maintaining a normal day-to-day life. It is extremely necessary that the general population and those affected by cancer push for more research and have that research acknowledged by the FDA.”

Researchers have yet to identify cannabis treatments that definitely cure cancer when used at a specific strength, in a specific mix, and/or within a specific timeframe. But they also can’t prove that chemotherapy or any of the other treatments for breast cancer definitely cures the disease.

Because of the lack of medical research with cannabinoids it’s not clear if either natural, synthetic or combination of both types of cannabinoids are more effective, what doses might be required, or how specific cancers will respond to them. The correct course of treatment might very well be individualized treatment based on one’s biochemistry in conjunction with the type of cancer. So we’re far away from “take two every 8 hours for the next 4 weeks and we’ll test again.”

Clinical research and treatment is not done with street drugs. It is done with purified drugs in controlled, high dose treatments. Centuries of human experimentation proves that naturally occurring cannabinoids are broadly safe and exhibit relative few side effects beyond dizziness, fatigue, and increased heart rate and appetite. Not bad, when considering the very scary lists of drug related side effects you constantly hear on TV or read about in drug ads.

I am not a doctor. I am a 67 year old breast cancer survivor who did not take chemotherapy. However, taking cannabinoid medication for preventing and treating breast cancer makes sense to me. If my cancer were to reappear tomorrow, I would certainly want access to any and all breast cancer and immune boosting cannabinoid medication (trial or other) that I could get my hands on – immediately. As breast cancer patients, we should collectively speak out for increasing the clinical trials of cannabis medications for boosting the immune system to prevent the breast cancer from recurring, and to help our bodies kill it when it returns.