R E V I E W A review of nabilone in the treatment of chemotherapy-induced nausea and vomiting Mark A Ware1 Paul Daeninck2 Vincent Maida3 1Pain Center, McGill University Health Center, Montréal, Quebec, Canada; 2Pain and Symptom Clinic, CancerCare Manitoba, Winnipeg, Manitoba, Canada; 3University of Toronto, Toronto, Ontario, Canada Correspondence: Mark Ware E19.145 Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4 Tel +1 514 934 8242 Fax +1 514 934 8096 Email mark.ware@muhc.mcgill.ca Abstract: Chemotherapy-induced nausea and vomiting (CINV) in cancer patients places a signiﬁcant burden on patients’ function and quality of life, their families and caregivers, and healthcare providers. Despite the advances in preventing CINV, a substantial proportion of patients experience persistent nausea and vomiting. Nabilone, a cannabinoid, recently received Food and Drug Administration approval for the treatment of the nausea and vomiting in patients receiving cancer chemotherapy who fail to achieve adequate relief from conventional treatments. The cannabinoids exert antiemetic effects via agonism of cannabinoid receptors (CB1 and CB2). Clinical trials have demonstrated the beneﬁts of nabilone in cancer chemotherapy patients. Use of the agent is optimized with judicious dosing and selection of patients. Keywords: nabilone, chemotherapy-induced nausea/vomiting, pain The burden of chemotherapy-induced nausea and vomiting In the absence of preventive therapy, 70%–80% of cancer patients receiving chemo- therapy experience associated nausea and vomiting (Morran et al 1979; Jenns 1994). Chemotherapy-induced nausea and vomiting (CINV) and its side effects imposes a burden on patients, clinicians, and the healthcare system (Vanscoy et al 2005; Wiser and Berger 2005). Of all the side effects of chemotherapy, CINV remains one of the most dreaded by patients (Sun et al 2004). Patients report a substantial negative impact of CINV on their ability to complete activities of daily living, obtain adequate rest, participate in social activities, and perform work (Lee et al 2005; Wiser and Berger 2005). Further, CINV can have deleterious physiologic effects, including metabolic derangements, malnutrition, and esophageal tears, among others (Wiser and Berger 2005; National Comprehensive Cancer Network 2006). In up to 30% of patients, CINV is so distressing that consideration is given to discontinuing treatment, which underscores the need for effective control of the nausea and vomiting associated with chemotherapy (Wiser and Berger 2005). The introduction of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists has had a dramatic effect on preventing CINV in cancer patients (Abrahm 2005). With clinical experience, however, it has become apparent that while these agents are effective for controlling acute CINV, they are ineffective agents for delayed nausea (Hickok et al 2003; Kris et al 2006). The substance P/neurokinin 1 (NK1) receptor antagonist, aprepitant, augments the antiemetic action of 5-HT3 receptor antagonists and corticosteroids such as dexamethasone. The most effective way of controlling delayed nausea and vomiting is to prevent the acute phase; as such, the addition of aprepitant to antiemetic regimens has assisted clinicians in controlling both acute and delayed CINV (Schwartzberg 2006). The recently revised American Society of Clinical Oncology (ASCO) Guidelines, as well as those from the Multinational Association Therapeutics and Clinical Risk Management 2008:4(1) 99–107 © 2008 Dove Medical Press Limited. All rights reserved 99