Discussion
inflammation, cancers, cancer, adult cancer
SYSTEMIC INFLAMMATORY RESPONSE, CANCERS, INFLAMMATION, CANCER, ADVANCED CANCER, CORONAVIRUS
There has been considerable pre-clinical work suggesting that CBD has an anti-inflammatory effect [Median CRP at baseline was of sufficient magnitude to be susceptible to any anti-inflammatory effect of CBD. Minor discrepancies between the lower limit of “normal” CRP between laboratories were allowed for by the calculation of median change in CRP levels as opposed to absolute change.The 37-plex Bio-Plex Pro™ human inflammation panel allowed for the detection of a wide range of pro- and anti-inflammatory markers and has been used previously to reflect various pathophysiological conditions and inflammation status in patients [These results are consistent with a recent randomised controlled trial in which CBD was tested against placebo for the management of symptoms of coronavirus in which a range of inflammatory cytokines were tested and found not to be impacted by cannabis use [The lack of benefit on average does not preclude benefit in select cases. There may be certain characteristics in either the patient or the cancer which predict anti-inflammatory response to CBD. Future investigators may consider restricting their population to patients with those cancers suggested to elicit a more pronounced systemic inflammatory response [Around one-half of all patients in this study were receiving anti-cancer therapy and most were on corticosteroids, but there was no significant difference in proportions of patients on these therapies between the treatment groups.This study utilised a pure synthetic CBD product. It is possible that any anti-inflammatory effect of cannabinoids relies on the presence of terpenes and other components contained plant-based products through an “entourage” effect. Similarly, there is some existing research suggesting an anti-inflammatory effect for combined THC and CBD in animals but no studies to date in an adult cancer population. We are planning a similar study in patients with advanced cancer administered a THC/CBD (1:20) oral suspension or placebo as part of a larger study assessing the benefit of this product for reducing total symptom burden.In summary, we found no evidence to suggest that CBD has an anti-inflammatory role in patients with advanced cancer and no indication to proceed with this agent to a larger, properly powered, prospective study. The potential role if any of THC deserves further investigation.