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Practice Guideline
. 2024 May 1;42(13):1575-1593.
doi: 10.1200/JCO.23.02596. Epub 2024 Mar 13.

Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline

Ilana M Braun  1 , Kari Bohlke  2 , Donald I Abrams  3 , Holly Anderson  4 , Lynda G Balneaves  5 , Gil Bar-Sela  6 , Daniel W Bowles  7 , Peter R Chai  8 , Anuja Damani  9 , Arjun Gupta  10 , Sigrun Hallmeyer  11 , Ishwaria M Subbiah  12 , Chris Twelves  13 , Mark S Wallace  14 , Eric J Roeland  15
Affiliations
Practice Guideline

Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline

Ilana M Braun et al. J Clin Oncol. .

Abstract

Purpose: To guide clinicians, adults with cancer, caregivers, researchers, and oncology institutions on the medical use of cannabis and cannabinoids, including synthetic cannabinoids and herbal cannabis derivatives; single, purified cannabinoids; combinations of cannabis ingredients; and full-spectrum cannabis.

Methods: A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and cohort studies on the efficacy and safety of cannabis and cannabinoids when used by adults with cancer. Outcomes of interest included antineoplastic effects, cancer treatment toxicity, symptoms, and quality of life. PubMed and the Cochrane Library were searched from database inception to January 27, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations.

Results: The evidence base consisted of 13 systematic reviews and five additional primary studies (four RCTs and one cohort study). The certainty of evidence for most outcomes was low or very low.

Recommendations: Cannabis and/or cannabinoid access and use by adults with cancer has outpaced the science supporting their clinical use. This guideline provides strategies for open, nonjudgmental communication between clinicians and adults with cancer about the use of cannabis and/or cannabinoids. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. Cannabis and/or cannabinoids may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant antiemetic regimens. Whether cannabis and/or cannabinoids can improve other supportive care outcomes remains uncertain. This guideline also highlights the critical need for more cannabis and/or cannabinoid research.Additional information is available at www.asco.org/supportive-care-guidelines.

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Conflict of interest statement

The Expert Panel was assembled in accordance with ASCO’s Conflict of Interest Policy Implementation for Clinical Practice Guidelines (“Policy,” found at https://www.asco.org/guideline-methodology). All members of the Expert Panel completed ASCO’s disclosure form, which requires disclosure of financial and other interests, including relationships with commercial entities that are reasonably likely to experience direct regulatory or commercial impact as a result of promulgation of the guideline. Categories for disclosure include employment; leadership; stock or other ownership; honoraria, consulting or advisory role; speaker’s bureau; research funding; patents, royalties, other intellectual property; expert testimony; travel, accommodations, expenses; and other relationships. In accordance with the Policy, the majority of the members of the Expert Panel did not disclose any relationships constituting a conflict under the Policy.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Disclosures provided by the authors are available with this article at DOI https://doi.org/10.1200/JCO.23.02596.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Ilana M. Braun

Honoraria: Elimu Informatics

Donald I. Abrams

Stock and Other Ownership Interests: Lumen, Cannformatics, Wellkasa

Consulting or Advisory Role: Wellkasa, Cannabotech

Patents, Royalties, Other Intellectual Property: Royalties from my Oxford University Press text book Integrative Oncology

Lynda G. Balneaves

Uncompensated Relationships: Canadian Consortium for the Investigation of Cannabinoids

Gil Bar-Sela

Honoraria: BMS, MSD Oncology, Abbott Nutrition

Daniel W. Bowles

Consulting or Advisory Role: Exelixis

Peter R. Chai

Stock and Other Ownership Interests: Biobot Analytics

Consulting or Advisory Role: Syntis Bio

Research Funding: E Ink Corporation

Arjun Gupta

Employment: Genentech/Roche (I)

Sigrun Hallmeyer

Leadership: Association of Community Cancer Centers (ACCC)

Honoraria: Cardinal Health

Consulting or Advisory Role: Cardinal Health

Travel, Accommodations, Expenses: Cardinal Health

Uncompensated Relationships: Society for Immunotherapy of Cancer

Ishwaria M. Subbiah

Consulting or Advisory Role: MedImmune

Research Funding: Bayer, Novartis, GlaxoSmithKline, NanoCarrier, Celgene, Northwest Biotherapeutics, Incyte, Fujifilm, Pfizer, Amgen, Abbvie, Multivir, Exelixis, Loxo, Blueprint Medicines, Takeda

Chris Twelves

Honoraria: Eisai, Daiichi Sankyo, Pfizer, Novartis

Consulting or Advisory Role: Eisai, Pfizer, Daiichi Sankyo

Speakers’ Bureau: Eisai, Daiichi Sankyo, Pfizer

Research Funding: Avacta Life Sciences, AstraZeneca, Pfizer

Travel, Accommodations, Expenses: Eisai, Pfizer, MSD Oncology

Mark S. Wallace

Consulting or Advisory Role: GW Pharmaceuticals

Eric J. Roeland

Consulting or Advisory Role: Napo Pharmaceuticals, Byomass, Veloxis, PRA Health, Actimed Therapeutics, Takeda, meter health

Travel, Accommodations, Expenses: Pfizer

No other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
Endocannabinoid System. The endocannabinoid system exerts a widespread neuromodulatory effect. Research has identified two endocannabinoids (anandamide and 2-arachidonoylglycerol), two catabolic enzymes (ie, fatty acid amide hydrolase and monoacylglycerol lipase), and two main endocannabinoid g-protein–coupled receptors (CB1 and CB2). CB1 receptors are found at high concentrations in the brain and peripheral nervous system, operating in a retrograde fashion (ie, endocannabinoids bind to CB1 receptors on presynaptic terminals) to modulate activity of several other noncannabinoid neurotransmitters. CB1, cannabinoid receptor type 1; CB2, cannabinoid receptor type 2.
See this image and copyright information in PMC

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