In March 2006, P.K., a 14-year-old girl from Toronto who we will call Phoebe, developed bruising and shortness of breath. Upon going to a Toronto hospital, doctors determined that she had an aggressive form of cancer called acute lymphoblastic leukemia, also known as ALL. At the time of diagnosis, she had over 300,000 blast cells,* abnormal blood cells that interfere with normal cell function.

Transplant and Chemotherapy to Kill Cancer

Phoebe began chemotherapy shortly after her diagnosis. In August 2006, when it was evident that the standard chemotherapy had failed, Phoebe received a bone marrow transplant. The transplant process, which kills off all remaining white blood cells before replacing them with transplant cells, leaves the body vulnerable to infection. Phoebe was isolated for 45 days after the transplant. At a follow-up appointment in February 2007, doctors observed more blast cells in her blood, indicating that the transplant had been unsuccessful. Phoebe was then treated with a more aggressive chemotherapy regimen, but after nine months, her cancer was still not responding. More treatments followed, but doctors were running out options.
In July 2008, Phoebe, now 16, was rushed to the hospital with a severe headache. A number of tests, including a CT scan of her head, indicated that blast cells had metastasized to her brain. On February 4, 2009, Phoebe experienced internal bleeding, and blood tests showed a growing number of blast cells. Phoebe was suffering from terminal cancer and all available therapy had failed. Doctors wrote in her chart that “no further active intervention will be undertaken,” and Phoebe was taken to an end-of-life care facility.

turning to medical marijuana

Told that Phoebe had two months to live, Phoebe’s family was desperate for an alternative treatment. Having read that marijuana might have cancer fighting properties, they obtained cannabis oil extract through a local organization. On the morning of February 21, 2009, Phoebe began the alternative treatment, beginning with one drop of cannabis oil. The family’s plan was to increase the amount to the highest dose she could tolerate. They mixed the bitter oil with honey to improve its taste. Phoebe underwent a series of blood tests that allowed doctors to monitor her blast count. The results were astounding: Though the blast count rose to a peak of 374,000 during the first five days of treatment, as they increased her dose by a drop a day, the blast count then decreased to 61,000 by day 15, a dose-related response to the amounts of cannabis oil. There was a problem, however: When the family’s local organization ran out of oil, there was no guarantee that cannabis oil obtained from a different source would have the same effect as the oil they had been using.

Would Another Cannabis KILL CANCER?

Marijuana plants contain over 500 constituents including cannabinoids that have medicinal properties, the most recognizable of which is THC (tetrahydrocannabinol). The specific class and concentration of medicinal cannabinoids varies among different strains of marijuana. Phoebe’s family was able to get a new source of oil to continue treatment, but would it continue to be effective?
After resuming treatment with the new oil, the blast count began to rise over the following week. The count rose from 35,000 on day 18 of treatment to 66,000 on day 27 as the family continued increasing the dose of the new cannabis oil. Then something changed. The blast count started to decrease rapidly, an effect that Phoebe’s family attributed to her cannabis oil treatment. On day 29, the count was 35,000; on day 32, it was 7,000; on day 36, it was 2,000. By day 40, the count decreased to approximately 500, where it held steady until the batch of oil had been completed.

Infection Threatens phoebe’s Life

Phoebe remained very sick despite the medical marijuana’s positive effect on her blast count. Her cancer and the many rounds of treatment had taken their toll on her body over the past three years. Phoebe was severely undernourished, underweight and ill. A common side effect of therapies designed to kill cancer cells is the destruction of healthy cells. Phoebe, having lost the ability to fight off routine infections, developed a chronic stomach infection, a dangerous condition affecting her entire colon.
Phoebe’s family replaced the cannabis oil on day 50, and when the blast count began to increase steadily, they replaced the batch with what was now the fifth strain of cannabis oil they had used. This strain brought the blast count down to 1,000 by day 76.

On May 8, 2009, Phoebe was feeling sick and had a bad stomach ache. Her family rushed her to the hospital where an X-ray showed internal bleeding. The infection had perforated her bowel. Her vital signs were falling and she went into cardiac arrest. Because there was a DNR order (do not resuscitate) in place, CPR was not performed. Phoebe passed away at 10:05 a.m. surrounded by her family and loved ones.

Spontaneous Remission or Marijuana killing cancer?

The response of Phoebe’s cancer to medical marijuana appeared to be powerful. During her treatment with cannabis oil, Phoebe was in palliative care and was not receiving any other anti-cancer medication. While cancer cell counts can decrease for unknown reasons, in a phenomenon called “spontaneous remission,” the pattern in Phoebe’s response to cannabis oil treatment suggested that spontaneous remission was not a factor in her blast count.

As Phoebe took higher doses of medical marijuana, the number of cancerous blast cells decreased proportionately, a fact that argued against spontaneous remission. In addition, when different strains of cannabis oil were introduced, her blast counts consistently rose before falling further. The graph to the right shows the course of treatment, including each time new cannabis oil was introduced. It seemed likely that the spikes in blast count were a direct result of the differing concentrations of cannabinoids in the different oils. When each new oil was introduced, a spike occurred while the family attempted to find the ideal dose. Once that dose was determined, the blast counts would drop again. Given the positive response of her cancer to medical marijuana, it is possible that Phoebe’s outcome would have been better had she started medical marijuana treatment at the outset of her disease. Whether it would have made a difference, however, is a question that can never be answered.

Phoebe’s story appeared in a peer-reviewed oncology journal, and suggests that medical marijuana was effective in reducing blast counts in her particular case. Could medical marijuana improve outcomes of other cancer patients in the future? Only a handful of studies have tested medical marijuana’s effect on a patient’s cancer. Research would need to replicate these results on a large scale for the scientific community to consider cannabis as a legitimate cancer treatment. For now, medical marijuana has evidence-based applications in treating cancer symptoms in the present.

treating Cancer Symptoms with Medical Marijuana

Medical marijuana is effective in treating nausea and pain in cancer patients. It is a safe treatment compared with other medications, making it acceptable to many doctors. Patients experiencing nausea or pain should discuss the use of medical marijuana with their oncologists before starting any treatment. While unlikely, medical marijuana could worsen certain cancers or interfere with the metabolic function of chemotherapy drugs.

Phoebe’s story provides hope that medical marijuana might be useful as a supplement to cancer treatment. Its use has already been shown to relieve symptoms of nausea and pain, and should be considered as a palliative treatment. More importantly, Phoebe’s experience certainly makes a strong case for research into medical marijuana’s potential to treat cancer.

Notes

1. Blast Cell Counts are commonly provided in units of a μl (microliter) or one millionth of a liter.

References

Singh, Y., & Bali, C. (2013). Cannabis extract treatment for terminal acute lymphoblastic leukemia with a Philadelphia chromosome mutation. Case reports in oncology, 6(3), 585-592.

Michael Morgenstern, MD

Michael Morgenstern, MD

Founder at NY Medical Marijuana Association
About the author: Dr. Michael Morgenstern is double board certified in Neurology and Sleep Medicine. He works in private practice in Manhattan, Queens and Long Island and has extensive expertise treating patients with Medical Marijuana.
Michael Morgenstern, MD

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