The Cannabis plant has many properties that either interact with the cannabinoid receptors in our bodies or share chemical similarities with our own system, among them pain relief, anti-anxiety, anti-seizure, anti-nausea, anti-inflammatory, antioxidant, anti-tumor, as well as neuroprotective effects. The most studied of the cannabinoids are THC and CBD. THC has a strong effect on our nervous system, but weak on our immune, and has psychoactive effects. CBD, on the other hand, has both weak effects on our nervous and immune systems, without psychoactive effects.
The prevailing recommendation is to start low, go slow, and stay low; and the best dose is the one that is lowest you can take and still get some relief and can tolerate. Questions to ask during a consultation are:
Watch now: “Medical Cannabis: What You Need to Know,” and other informational videos originally presented at our 2020 virtual National Conference are now available in their entirety on our website. View all ovarian cancer videos.
When taking orally, such as through CBD oil, the general rule is to start with a low dosage and very gradually increase as needed. As of now, there are no well-established dosing guidelines for CBD. If well tolerated by the patient, oral ingestion can be particularly helpful with relieving chronic pain, though it is important to keep in mind there may be psychoactive effects. A CBD dosage of 5-20mg/day may provide some benefit, and it may be helpful to take throughout the day – for example, if taking 10mg in total, divide into doses of 3mg three times per day, or 5mg twice per day.
Can CBD Help With Ovarian Cancer?
Cannabis is a plant from the Cannabaceae family and it has been used medicinally since before written history. Its first recorded use can be traced back 3,500 years ago in Egypt and in 1 st and 2 nd century China, though it was only introduced to western medicine in the 1840’s as an antidote to rabies. In 1937, it was effectively banned in the U.S. via a very high tax, and in 1970, cannabis was given Schedule 1 classification indicating “high risk abuse, with no accepted medical use.”
Ca-125 trend on treatment.
Perhaps most provocative is the recent report that 40% of Americans believe that use of CAM is sufficient for the management of cancer (National Cancer Opinion Survey, 2019). In addition, 22% of Americans with a history of a cancer diagnosis and 38% of family caregivers share this belief. However, a recent study evaluated overall survival and adherence to treatment in patients receiving conventional cancer treatment with or without CAM for cancers considered curable. Patients who used CAM had significantly decreased overall survival when compared to those who did not, and also had higher rates of refusal of standard therapy (Johnson et al., 2018). Notably, this risk of death is linked to the refusal of therapy and not to the use of CAM itself. This demonstrates the importance and need for transparent, open discussions with patients regarding current available therapies, expected outcomes, and alternatives that patients may be seeking or have not yet disclosed.
After extensive counseling, the patient declined all interventions due to concerns regarding quality of life and treatment toxicity. She elected to pursue alternative therapy and started Laetrile tablets (500 mg orally four times per day) and cannabidiol (CBD) oil (1 drop sublingually each evening) in May 2017. Her Ca-125 level in May 2017 was 46, and after one month on the above regimen, her Ca-125 normalized to 22 ( Fig. 2 ).
Following the above surgery, she underwent diagnostic imaging, with computed tomography (CT) scan of the chest, abdomen and pelvis demonstrating multiple mesenteric soft tissue masses ranging from 7 mm to 7 cm and omental carcinomatosis. A 5.8 cm solid right adnexal mass and 3.3 cm solid left adnexal mass were also identified ( Fig. 1 ). Lymphadenopathy was noted along the left common iliac vessels and the left pelvic sidewall. She was subsequently referred to our practice for consultation and based on imaging and clinical examination, neoadjuvant carboplatin/paclitaxel with interval cytoreduction was recommended. She denied any known family history of cancer and BRCA 1 and 2 germline testing was negative. Her pathology was reviewed at our institution and confirmed to be LGSOC with low grade atypia and occasional psammoma bodies. The submitted tissue sample was estrogen and progesterone receptor positive.
In an effort to improve oncologic outcomes, investigators have attempted to capitalize on molecular aberrations identified in LGSOC specimens. Most recently, the utilization of MEK inhibitors have been explored due to noted activation of the mitogen-activate protein kinase (MAPK) pathway in LGSOC. A phase II trial evaluating Selumatib activity in women with recurrent LGSOC (GOG 0239) demonstrated a 15% overall response rate, catalyzing the development of phase III trials examining alternate agents in this setting (Farley et al., 2013). A phase III study evaluating Trametinib vs. physicians choice chemotherapy in patients with recurrent or progressive LGSOC (GOG-281) has closed to accrual and will help guide further management with these targeted agents. Furthermore, efforts to identify appropriate patient subsets based on molecular profiling are ongoing. In context of the above, optimal management of these relatively chemotherapy-resistant tumors due to their low-grade nature remains an active area of investigation.