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Help, and hope: Could cannabis possibly help fight cancer?

Confusion about cannabis and cancer is deepened by the lack of scientific evidence

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John Kofel was devastated when a biopsy last October showed he had metastatic prostate cancer. Having had a daughter diagnosed with breast cancer in her 30s, he knew firsthand the nightmare cancer can become.

After Kofel made a follow-up visit to an oncologist, his mood changed from shock to anger, not that he had cancer, but at his doctor.

“He was very discouraging, in general,” Kofel recalled. “ ‘You might have 31 months to live.’ … Leaving, I was clearly dazed. I thought, ‘I’m a dead man.’ ”

He also knew that doctor wasn’t for him. (Memo to all cancer patients: If you learn nothing else from this ongoing journal, make sure you have doctors fighting for you.)

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Kofel soon after sought a second opinion and was referred to Dr. Edward (Ted) Eigner, of Urology Associates, who changed his life.

“It was like night and day,” Kofel said. “He said, ‘Yes, you have metastatic cancer, but it’s a very solvable, meaning controllable, issue. … It’s very treatable.’ ”

The bioposy of his prostate, after all, showed only four of 12 samples positive for cancer, with a spread to the pelvic bone and one femur. With newfound optimism, Kofel became obsessed about researching a game plan to fight the cancer. He revamped his diet, including what he drank (now exclusively alkaline water), and began taking a list of supplements that fills an 8- by 11-inch notebook page — single spaced. And, in December, he began ingesting oils derived from marijuana plants.

“I’m trying to leave no stone unturned, attacking it from all sides,” Kofel said.

The cannabis oils he uses contain concentrated amounts of two plant compounds: tetrahydrocannabinol (THC), the psychoactive component of marijuana that gets you high, and cannabidiol (CBD), a non-intoxicating substance that has gained fame for its purported medicinal benefits.

“The combination of both (CBD and THC) causes apoptosis; cannabis tends to go to cancer cells weakened due to chemotherapy and causes them to kill themselves,” Kofel said.

“There is data to suggest cannabis can kill cancer cells in the lab,” said Cindy O’Bryant, a professor at the University of Colorado Skaggs School of Pharmacy. “It appears to affect cancer cells and not normal cells, unlike chemotherapy does, but this is happening in a dish, in the lab, not the human body. Getting it in people to see if it has an effect, therein lies the problem.”

The truth is, as much as is known about cannabis and its effects on the human body, little is known regarding its safety and effectiveness in fighting cancer.

Q&A with Dr. Daniel Bowles

Following are excerpts from an interview with Dr. Daniel Bowles, who has been studying cannabis for several years. Bowles is an investigator at the University of Colorado Cancer Center.

Q. Where is the research in terms of whether cannabis causes cancer?

A. “The data regarding cannabis use as a risk factor for cancer development is mixed. The strongest data suggesting a link is from a large study from Sweden which demonstrated that heavy marijuana smokers at a young age were at a higher risk of lung cancer later in life. There are also some suggestions that it might increase the risk of testicular cancer. It has been more difficult to show that marijuana smoking increases the risks of other cancers. There is exceedingly little information about cancer risk and other forms of cannabis ingestions (vaporized, edibles, etc.).”

Q. Where is the research in terms of whether cannabis or cannabis-related products can control cancer symptoms?

A. “When we think of levels of evidence for a treatment, the strongest version is a randomized controlled trial (RCT). There are a few RCTs that demonstrate that smoked cannabis is more effective than a placebo at treating certain pain conditions, especially neuropathic pain. An agent called nabiximols that combines THC and another cannabinoid demonstrated some effectiveness in addition to opiates in cancer patients.

“Regarding appetite, there was an RCT comparing a cannabis extract with two other medications used to treat anorexia, and it was less effective than those other two.”

Q. How much knowledge do oncologists have to be able to answer questions from patients about cannabis and cancer?

A. “It’s fairly mixed. Some oncologists are quite knowledgeable, and others are not and feel very uncomfortable.”

Q. If there isn’t any proof that cannabis products help fight cancer, why are so many patients using them?

A. “Many patients are hopeful that it’s an alternative to supplement their routine care. In my mind, I think people view it as similar to trying vitamins or herbals for other conditions where there is a similar lack of data.

“The biggest issue here is what patients are doing in the real world with smoked products, edibles, extracts and other preparations is largely unstudied.”

Q. With the federal government’s view of marijuana, how difficult is it to do research, such as clinical trials, to really know what is going on?

A. “It’s very difficult to do research in this field for several reasons. First, the marijuana approved for research provided by the (National Institutes of Health) NIH is not very similar to the marijuana people can buy in a dispensary, so it’s difficult to tell whether studies using this marijuana reflect real world usage. Second, the laws regarding drugs in school settings make it difficult to perform research at universities. Lastly, I’m not sure there is a large amount of community support for these studies, as people can currently go use marijuana without any supporting data.

“I do think we’re making some headway. The state of Colorado funded several grants to evaluate marijuana’s role in several diseases. There is more going on in the pharmaceutical end, too. For instance, a study was just published in the New England Journal of Medicine evaluating the effectiveness of cannabidiol (CBD) for treating refractory seizures in a condition called Dravet syndrome.

“In my mind, if we’re going to treat cannabis and cannabinoids like medications, we need to study them like medications. …The best way to study this going forward is with pharmaceutical-grade products with known dosing and schedules.”

Drive west toward Denver when exiting the University of Colorado Cancer Center in Aurora, and you’ll soon pass a marijuana dispensary, Altitude, on your right. A dozen or so more dispensaries dot Colfax Avenue before you reach downtown.

In a state where marijuana has become omnipresent, perhaps it’s not a surprise that 53 of 185 cancer patients who filled out a recent survey at the CU Cancer Center said they use some type of marijuana product. That’s 28.6 percent, almost double the rate of marijuana usage of those 18 years or older in Colorado (17 percent), according to CU. The voluntary, anonymous survey, conducted by O’Bryant, showed the vast majority of the patients (81 percent) who use marijuana are doing so to treat side effects of their cancer treatment, such as fatigue, loss of appetite, irregular sleep and pain. Around 19 percent say they are using marijuana to treat the cancer itself.

Interest in the issue is clearly on the rise.

“We’re getting more and more questions about it as regulatory issues become more relaxed,” O’Bryant said. “Not necessarily older patients who are asking, but sons and daughters are asking about it.

“Patients view it as a natural product, so it’s safe, but we really don’t know how it interacts with other drugs.”

She would like to know, as would many of her colleagues, but with the federal government having classified cannabis as a Schedule I drug in the Controlled Substances Act, research hospitals such as CU are stymied.

“Our neurology department has been a big supporter (of research),” O’Bryant said. “We would like to do more research in current cancer patients. But there are a lot of hoops to jump through. To work with the FDA, to bring a drug to market, we have to take on liability. … We get federal funds, so there’s always trepidation research funding could be negatively affected.”

One of the most frustrating aspects of having cancer is the uncertainty: the uncertainty of what will happen next, yes, but also the uncertainty of which drug sequencing or treatment option offers the best hope. Often it’s simply a gut call, a best guess. You can now add “Could cannabis possibly help?” to the list.

Confusion about cannabis and cancer is deepened by a lack of scientific evidence, despite wild, anecdotal claims of its curative powers found on the internet.

For now, Kofel, who lives in Aurora, will keep doing what he’s doing. Twice a day, he takes CBD and THC oils orally via a dropper. He gets the oils, which are bottled as a tincture, from a local provider.

“Do your homework; get good stuff from reliable people,” said Kofel, 72, who has a medical marijuana card.

Upon his diagnosis last fall, he was immediately put on Lupron, a drug used to reduce the production of testosterone, which feeds prostate cancer, and lower a man’s prostate-specific antigen (PSA). He soon after underwent chemotherapy (docetaxel), six rounds. His PSA has dropped from 82 to 0.22. (PSA is a protein produced by the prostate; any number above 4.0 is cause for concern.)

“My doctor told me, ‘Whatever you’re doing, it’s working,’” he said.

He’s planning to start radiation Monday to deliver what he hopes is a final, knockout blow.

“No one is using the word cure,” Kofel said. “But my mind-set is I can cure this.”

Scott Monserud: 303-954-1578, [email protected] or @monserud

News update

Results released last month of a clinical trial of nearly 2,000 prostate cancer patients showed that adding abiraterone acetate (Zytiga) to a standard initial treatment for high-risk, advanced prostate cancer not only prolonged life but lowered the chance of relapse by 70 percent.

My take: It’s huge, positive news for patients with metastatic prostate cancer. Finding the right sequencing of drugs remains a key to making metastatic prostate cancer a chronic disease and not a death sentence, along with advancing immunotherapy research. There is currently only one immunotherapy, Provenge, approved by the FDA to treat prostate cancer. Men older than 50: Get your PSA tested yearly.

My treatment: No changes; I remain on Lupron

If you have a question you’d like answered, please send it to me.

How do I find an optimal low dose that will help with my cancer?

I have been using cannabis oil for 3 months for prostate cancer (as a complementary to conventional cancer treatments) in hopes that it would help slow the progression. In the 3 months since I started I have not been able to take anywhere close to the 750 mg. of combined (CBD & THC) oil that I’m supposed to take because it is just too much (it makes me very anxious and depressed if I take too much).

You have mentioned another method of taking a low daily dose of cannabis as an alternative. How do I find an optimal low dose that will actually help with my cancer?

Dr. Sulak’s Answer

Great question! Please know that you’re not the only one that finds it challenging to work up to the very high doses of cannabinoids that are often recommended to cancer patients.

Many patients find that they are able to increase the ratio of CBD:THC to avoid some of the side effects you described (anxiety and depression), especially when taking the cannabis during the day. It can also be helpful to increase the dose of THC before bed so that you sleep through the most psychoactive side effects, but be careful – I have heard many reports of patients taking too much THC before bed and waking up to a full-blown panic attack. Overall, finding the right ratio of cannabinoids, timing the doses right, and gradually increasing the dose at the right rate are keys to success. Even so, some patients simply cannot tolerate these very high doses no matter what they try, and if you are one of these people, I do recommend listening to your body and changing paths.

Right now, all we know regarding the optimal dose of cannabis to treat cancer comes from anecdotes and expert opinions. The vast majority of success stories do involve very high doses, similar to what you’ve been attempting to reach. There are also some individuals that report great success in preventing cancer growth or inducing cancer remission when using only low doses of cannabis. I suspect that at high doses, the cannabinoids have specific anti-cancer mechanisms of action, which have been demonstrated in preclinical research. At low doses, the anti-cancer effect may be due to improved function of the patient’s healing system via immune modulation, decreased stress, improved sleep, increased self-awareness, and a number of other health-promoting properties associated with low dose cannabis use.

It’s also important to keep in mind that there are thousands of cases of spontaneous cancer regression that do not involve cannabinoids. Medical researchers have documented these cases and seek to understand common factors linked to these examples of spontaneous healing, which often occur in the absence of anti-cancer treatments. Dr. Kelly Turner identified these 9 factors common to most of the cases she evaluated:

  • radical diet change
  • taking control of their health
  • following their intuition
  • using herbs and supplements
  • releasing suppressed emotions
  • increasing positive emotions
  • embracing social support
  • deepening their spiritual connection
  • having strong reasons for living

To directly answer your question, the low dose of cannabis that would probably work best to help you heal your cancer is the same dose that helps you feel great, get restorative sleep, and, potentially, incorporate some of the factors described above. The Healer.com introduction to cannabis and sensitization programs can help you find your optimal low dose.

And remember, each of us never knows how many days we have left on this glorious planet. The goal is to make our remaining time as meaningful and enjoyable as possible. Cannabis can help with that when used appropriately. And when the end does come, cannabis offers great comfort and palliation during the transition through death.

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