Study register · detailRetrospektive Kohortenstudie · Cancer · 2021
Effect of cannabis on oxaliplatin-induced peripheral neuropathy among oncology patients: a retrospective analysis
Waissengrin et al.·Therapeutic Advances in Medical OncologyImpact 3.2
Clear benefitGRADELow29 citations
Samplen = 513 Pat.
DurationOctober 2015 to January 2018
ControlNo cannabis, n=265
EndpointCIPN grade
Blindingn.a.
DesignRetrospektive Kohortenstudie
”Key finding
Cannabis-exposed patients showed significantly lower rates of CIPN grade 2-3 (15,3% vs. 27,9%, p<0,001), with a stronger protective effect with prior cannabis exposure.
Summary
Retrospective analysis of n=513 patients with oxaliplatin-based chemotherapy (2015-2018); cannabis-exposed patients (n=248) vs. controls (n=265). CIPN grade 2-3 significantly less frequent with cannabis exposure (15.3% vs. 27.9%, p<0.001). Protective effect stronger with cannabis-before-oxaliplatin (cannabis-first, n=116) vs. oxaliplatin-first (n=132): 75% vs. 46.2% protection (p<0.001). Median cumulative oxaliplatin dose higher with cannabis-first (545 mg/m² vs. 340 mg/m² vs. 425 mg/m², p<0.001).
P
PopulationOncological patients under oxaliplatin-based chemotherapy without pre-existing neuropathy, n=513
I
InterventionCannabis (before or after oxaliplatin initiation), n=248
C
ControlNo cannabis (control), n=265
O
OutcomeCIPN grade 2–3 significantly less frequent with cannabis exposure vs. controls (15,3 % vs. 27,9 %, p<0,001); protective effect stronger for cannabis-first vs. oxaliplatin-first (75 % vs. 46,2 % reduction, p<0,001)
Confidence in the evidence
Very lowLowModerateHigh
Low
The second of four GRADE levels, the effect estimate is of limited reliability.
Quality profile
Sample size★★★★★
Blinding—
Effect sizeClear benefit
Citations / year★★★★★
Authors
Waissengrin B, Mirelman D, Pelles S, Bukstein F, Blumenthal DT, Wolf I, Geva R
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/m(2), 340 mg/m(2), and 425 mg/m(2) 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.