Study register · detailKohortenstudie · Cancer · 2019
Cannabis Impacts Tumor Response Rate to Nivolumab in Patients with Advanced Malignancies.
Taha et al.·The oncologistImpact 3.1
HarmGRADEModerate148 citations
Samplen = 140 Pat.
Duration2015-2016
ControlNivolumab alone
EndpointTumor response rate
Blindingn.a.
DesignKohortenstudie
”Key finding
Cannabis use during nivolumab therapy significantly reduced the response rate (37,5% vs. 15,9%, p=0,016), with no effect on progression-free survival or overall survival.
Summary
Retrospective cohort study n=140 (89 nivolumab mono, 51 nivolumab+cannabis) in advanced melanoma/NSCLC/renal cell carcinoma; cannabis use significantly reduced tumor response rate (37,5% vs. 15,9%, p=0.016, OR=3.13, 95% CI 1.24–8.1), with no effect on PFS or OS. THC/CBD percentages had no influence on RR (p=0.393/0.116).
P
PopulationAdults with advanced melanoma, non-small cell lung cancer or clear cell renal cell carcinoma under nivolumab therapy, n=140 (89 nivolumab alone, 51 nivolumab plus cannabis)
I
InterventionNivolumab plus cannabis (from six supply companies) during immunotherapy
C
ControlNivolumab alone (without cannabis)
O
OutcomeSignificantly reduced response rate in the cannabis group (15,9% vs. 37,5%; p=0,016, OR=3,13, 95%-CI 1,24–8,1); no significant difference in PFS or OS
Confidence in the evidence
Very lowLowModerateHigh
Moderate
The third of four GRADE levels, the effect estimate is probably reliable.
Quality profile
Sample size★★★★★
Blinding—
Effect sizeHarm
Citations / year★★★★★
Authors
Taha T, Meiri D, Talhamy S, Wollner M, Peer A, Bar-Sela G
Background: There has been a significant increase in the use of immunotherapy and cannabis recently, two modalities that have immunomodulatory effects and may have possible interaction. We evaluated the influence of cannabis use during immunotherapy treatment on response rate (RR), progression-free survival (PFS), and overall survival (OS).
Subjects, Materials, And Methods: In this retrospective, observational study, data were collected from the files of patients treated with nivolumab in the years 2015-2016 at our hospital, and cannabis from six cannabis-supplying companies. Included were 140 patients (89 nivolumab alone, 51 nivolumab plus cannabis) with advanced melanoma, non-small cell lung cancer, and renal clear cell carcinoma. The groups were homogenous regarding demographic and disease characteristics. A comparison between the two arms was made.
Results: In a multivariate model, cannabis was the only significant factor that reduced RR to immunotherapy (37.5% RR in nivolumab alone compared with 15.9% in the nivolumab-cannabis group (p = .016, odds ratio = 3.13, 95% confidence interval 1.24-8.1). Cannabis use was not a significant factor for PFS or OS. Factors affecting PFS and OS were smoking (adjusted hazard ratio [HR] = 2.41 and 2.41, respectively (and brain metastases (adjusted HR = 2.04 and 2.83, respectively). Low performance status (adjusted HR = 2.83) affected OS alone. Tetrahydrocannabinol and cannabidiol percentages did not affect RR in any group (p = .393 and .116, respectively).
Conclusion: In this retrospective analysis, the use of cannabis during immunotherapy treatment decreased RR, without affecting PFS or OS and without relation to cannabis composition. Considering the limitations of the study, further prospective clinical study is needed to investigate possible interaction.
Implications For Practice: Although the data are retrospective and a relation to cannabis composition was not detected, this information can be critical for cannabis users and indicates that caution is required when starting immunotherapy.