Anti-emetic efficacy and toxicity of nabilone, a synthetic cannabinoid, in lung cancer chemotherapy.

Ahmedzai et al. ·British Journal of Cancer Impact 6.0

Clear benefit GRADE Moderate 88 citations

Samplen = 34 Pat.

Duration3-day schedule of chemotherapy

ControlProchlorperazine

EndpointSymptom score

Blindingdoppelblind

DesignRCT (doppelblind, Crossover)

Cannabinoidthc

Routeoral

Key finding

Nabilone showed significantly better symptom scores for nausea, retching and vomiting as well as fewer vomiting episodes compared to prochlorperazine, without the need for additional parenteral antiemetics.

Summary

n=34 lung cancer patients, double-blind crossover study; nabilone (synthetic cannabinoid) vs. prochlorperazine during 3-day chemotherapy (CAE). Symptom scores for nausea, retching and vomiting significantly better under nabilone (p<0,05). Fewer patients vomited under nabilone (p=0,05); more patients preferred nabilone as antiemetic (p<0,005).

PopulationLung cancer patients undergoing 3-day chemotherapy (cyclophosphamide, adriamycin, etoposide), n=34

InterventionNabilone (synthetic cannabinoid), oral

ControlProchlorperazine

OutcomeSignificantly better symptom scores for nausea, retching and vomiting under nabilone vs. prochlorperazine (p<0,05); fewer patients vomited (p=0,05); more patients preferred nabilone (p<0,005)

Confidence in the evidence

Moderate

The third of four GRADE levels, the effect estimate is probably reliable.

Downgraded for

Imprecision

Quality profile

Sample size ★★★★★

Blinding Double-blind

Effect size Clear benefit

Citations / year ★★★★★

Authors

Ahmedzai S, Carlyle DL, Calder IT, Moran F

DOI 10.1038/bjc.1983.247↗

Design: RCT (doppelblind, Crossover)

Abstract

Nabilone, a synthetic cannabinoid, and Prochlorperazine were compared in a double-blind crossover study of 34 patients with lung cancer undergoing a 3-day schedule of chemotherapy with Cyclophosphamide, Adriamycin and Etoposide. Symptom scores were significantly better for patients on nabilone for nausea, retching and vomiting (P less than 0.05). Fewer subjects vomited with nabilone (P = 0.05) and the number of vomiting episodes was lower (P less than 0.05); no patients on nabilone required additional parenteral anti-emetic. More patients preferred nabilone for anti-emetic control (P less than 0.005). Adverse effects common with nabilone were drowsiness (57%), postural dizziness (35%) and lightheadedness (18%). Euphoria was seen in 14% and a "high" in 7%. Erect systolic blood pressure was lower in nabilone patients on Day 1 (P = 0.05) but postural hypotension was a major problem in only 7%. Nabilone is an effective oral anti-emetic drug for moderately toxic chemotherapy, but the range and unpredictability of its side-effects warrant caution in its use.

The impediment to action advances action. — Marcus Aurelius