Antiemetic Effect of Delta-9-Tetrahydrocannabinol in Patients Receiving Cancer Chemotherapy

Sallan et al. ·New England Journal of Medicine Impact 27.7

Clear benefit GRADE Moderate 360 citations

Samplen = 20 Pat.

Durationunclear

ControlPlacebo

EndpointAntiemetic effect

Blindingdoppelblind

DesignRandomized Controlled Trial

Cannabinoidthc

Routeoral

Key finding

Delta-9-tetrahydrocannabinol showed significant antiemetic effect in 14 of 20 treatment cycles versus 0 of 22 placebo cycles (P < 0,001).

Summary

Randomised, double-blind crossover RCT; n=20 evaluable cancer patients under chemotherapy. Oral THC antiemetically effective in 14/20 course sequences vs. 0/22 under placebo (p<0,001). No patient vomited during a subjective "high". First RCT evidence for THC as an antiemetic in chemotherapy-induced vomiting.

PopulationCancer patients under emetogenic chemotherapy, n=20 (evaluable)

InterventionOral delta-9-tetrahydrocannabinol (THC), crossover design

ControlPlacebo (oral)

OutcomeAntiemetic effect in 14/20 THC courses vs. 0/22 placebo courses; at study completion 12/15 vs. 0/14 (p<0.001)

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

Sallan S E, Zinberg N E, Frei E

DOI 10.1056/nejm197510162931603↗

Design: Randomized Controlled Trial

Abstract

Anecdotal accounts suggested that smoking Cannabis decreases the nausea and vomiting associated with cancer chemotherapeutic agents. Oral delta-9-tetrahydrocannabinol was compared with placebo in a controlled, randomized, "double-blind" experiment. All patients were receiving chemotherapeutic drugs known to cause nausea and vomiting of central origin. Each patient was to serve as his own control to determine whether tetrahydrocannabinol had an antiemetic effect. Twenty-two patients entered the study, 20 of whom were evaluable. For all patients an antiemetic effect was observed in 14 of 20 tetrahydrocannabinol courses and in none of 22 placebo courses. For patients completing the study, response occurred in 12 of 15 courses of tetrahydrocannabinol and in none of 14 courses of placebo (P less than 0.001). No patient vomited while experiencing a subjective "high". Oral tetrahydrocannabinol has antiemetic properties and is significantly better than a placebo in reducting vomiting caused by chemotherapeutic agents.

The impediment to action advances action. — Marcus Aurelius