Effect of cannabis on oxaliplatin-induced peripheral neuropathy among oncology patients: a retrospective analysis

Abstract

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and dosage-limited oxaliplatin-related toxicity. To date, there are no successful interventions for CIPN prevention or treatment. A therapeutic role for cannabis in diabetic and HIV-related peripheral neuropathy and a protective role in CIPN have been suggested. We examined the effect of cannabis on oncologic patients with CIPN. Methods: Medical records of 768 consecutive patients treated with oxaliplatin and 5-fluorouracil-based combinations at a tertiary medical center from October 2015 to January 2018 were reviewed. Excluded patients were those with pre-existing neuropathy or patients who received fewer than two cycles of oxaliplatin treatment. CIPN grade, oxaliplatin cumulative dose, and neuropathy-free survival were evaluated. The patients were divided based upon the exposure to cannabis: prior to oxaliplatin (cannabis-first), cannabis following the initiation of oxaliplatin treatment (oxaliplatin-first), and no exposure (control). Results: In total, 513 patients met the inclusion criteria, of whom 248 were treated with cannabis and 265 served as controls. The cannabis-first group included 116 (46.7%) patients and the oxaliplatin-first group included 132 (53.3%) patients. Demographic parameters were comparable between groups. There was a significant difference in CIPN grade 2–3 between cannabis-exposed patients and controls (15.3% and 27.9%, respectively, p < 0.001). The protective effect of cannabis was more pronounced among cannabis-first patients compared to oxaliplatin-first patients (75% and 46.2%, respectively, p < 0.001). The median oxaliplatin cumulative doses were higher in the cannabis-first versus the oxaliplatin-first versus the control groups (545 mg/m2, 340 mg/m2, and 425 mg/m2 respectively, p < 0.001). Conclusion: The rate of neuropathy was reduced among patients treated with cannabis and oxaliplatin. This reduction was more significant in patients who received cannabis prior to treatment with oxaliplatin, suggesting a protective effect. A large prospective trial is planned.

Endocannabinoid System Attenuates Oxaliplatin-Induced Peripheral Sensory Neuropathy Through the Activation of CB1 Receptors

“…Recently, the prevention of neuropathy caused by oxaliplatin-containing chemotherapy regimens, such as FOL-FOX, FOLFIRINOX/FOLFOXIRI, and FLOX, has been reported in patients using cannabis. A retrospective study showed that this effect is more preventive than therapeutic (Waissengrin et al 2021), which corroborates the data from the present study. Our results draw attention to the more evident participation of the CB1 receptor.…”

Cannabinoide Arzneimittel bei Krebspatient*innen

“…sogar verhindern [32]. In einer israelischen Beobachtungsstudie entwickelten Patient*innen unter Cannabis signifikant weniger CINP als Kontrollen [31].…”

Should oncologists trust cannabinoids?

“…This retrospective study included over 500 patients and divided them based on their exposure to medicinal cannabis (prescribed for other conditions such as nausea or anorexia) in: a. cannabis exposure prior to oxaliplatin chemotherapy, b. cannabis exposure following the initiation of oxaliplatin treatment, and c. no exposure (control). The authors noted a decrease in neuropathy incidence in cannabis users, especially in those that had been exposed to cannabis prior to starting chemotherapy, suggesting a protective effect for cannabis in this setting ( Waissengrin et al, 2021 ).…”