Long Term Safety of Sativex Oromucosal Spray (Sativex®; Nabiximols) as Adjunctive Therapy in Patients With Uncontrolled Persistent Chronic Cancer Related Pain

This was a 6-month, multicenter, non-comparative, OLE study to evaluate the safety of
long-term nabiximols use as an adjunctive measure in participants with advanced cancer. The
study provided continued availability of nabiximols to participants who completed a preceding
double-blind phase 3 study and de novo participants. Consenting eligible participants entered
the extension study (Day 1) on the same day as the "end of treatment" visit of a parent study
or within 7 days of the "end of treatment" visit or on the day of the "safety follow-up
visit" of the parent study. The "safety follow-up" visit of a parent study was performed on
the same day as Day 1, if the participant did not enter the OLE study on the same day as the
"end of treatment" visit of a parent study. De novo participants attended a screening visit 3
to 14 days prior to enrollment (Day 1). All participants commenced dosing on Day 1. Further
study visits took place after 2 weeks (Day 15), and every 4 weeks thereafter until the end of
treatment period on Day 183 or earlier if the participant withdrew from the study.

Treatment was started as a single spray in the evening on the first day (Day 1). Participants
then gradually titrated by 1 additional spray per day to an individualized dose, balancing
efficacy and tolerability. Participants had to complete titration within 14 days of their
first dose of study drug and then continue at the same dose for the remainder of the study.

Inclusion Criteria:

- Participant had completed the parent study within the last seven days

- Willing and able to give written informed consent

- Willing and able to comply with all study requirements

Exclusion Criteria:

- The participant was using cannabis or cannabinoid based medications, other than the
parent study investigational medicinal product (IMP), and was unwilling to abstain for
the duration of the study

- Any history or immediate family history of schizophrenia, other psychotic illness,
severe personality disorder or other significant psychiatric disorder other than
depression associated with their underlying condition

- Any known or suspected history of a substance abuse/dependence disorder (including
opiate abuse/dependence prior to the diagnosis of cancer), current heavy alcohol
consumption (more than 60 grams [g] of pure alcohol per day for men, and more than 40
g of pure alcohol per day for women), current use of an illicit drug or current
non-prescribed use of any prescription drug

- Had poorly controlled epilepsy or recurrent seizures (for example, one or more seizure
during the last year)

- Had experienced myocardial infarction or clinically significant cardiac dysfunction
within the last 12 months or had a cardiac disorder that, in the opinion of the
investigator would have put the participant at risk of a clinically significant
arrhythmia or myocardial infarction

- Had significantly impaired renal function

- Had significantly impaired hepatic function at the "end of treatment" visit of the
parent study

- Female participants of child-bearing potential and male participants whose partner was
of child-bearing potential, unless willing to ensure that they or their partner used
effective contraception, for example, oral contraception, double barrier,
intra-uterine device, during the study and for 3 months thereafter (however, a male
condom should not have been used in conjunction with a female condom as this may not
have proven effective)