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. 2021 Feb 9:13:1758835921990203.
doi: 10.1177/1758835921990203. eCollection 2021.

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

Barliz Waissengrin  1 , Dan Mirelman  1 , Sharon Pelles  1 , Felix Bukstein  1 , Deborah T Blumenthal  1 , Ido Wolf  1 , Ravit Geva  2
Affiliations

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

Barliz Waissengrin et al. Ther Adv Med Oncol. .

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.

Keywords: cannabis; neuropathy; oxaliplatin; palliation; side effects.

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Conflict of interest statement

Conflict of interest statement: Barliz Waissengrin: no conflict of interest. Dan Mirelman: no conflict of interest. Sharon Pelles: no conflict of interest. Felix Bukstein: no conflict of interest. Deborah T. Blumenthal: medical advisor: VBL, ViruCure; honoraria: Takeda, AstraZeneca. Ido Wolf: honoraria: BMS; lectures/research grant: Novartis, BMS, Roche; consulting and advisory: Roche. Ravit Geva: options: BOL Pharma; honoraria: MSD, Novartis, BMS, Roche, Janssen, Medison, Lilly, Bayer, Pfizer; consulting and advisory: BOL Pharma, MSD, Bayer, Novartis, Boehringer Ingelheim; travel, accommodations, expenses: Bayer, Merck, Medison, BMS.

Figures

Figure 1.
Figure 1.
Study flow chart.
Figure 2.
Figure 2.
Functionally disturbing neuropathy-free survival in pooled cannabis treatment group versus control group. CTX onset is the date chemotherapy starts.
Figure 3.
Figure 3.
Functionally disturbing neuropathy-free survival among cannabis-first, oxaliplatin-first, and control group. CTX onset is the date chemotherapy starts.
See this image and copyright information in PMC

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