CBD Oil And Immunotherapy

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The effect of concomitant cannabinoids during immune checkpoint inhibitor treatment of advanced stage malignancy. Background: Immune checkpoint inhibitors are used in treatment of advanced Cannabis administration can lower response rate for those undergoing immunotherapy, overall survival is not impacted.

The effect of concomitant cannabinoids during immune checkpoint inhibitor treatment of advanced stage malignancy.

Background: Immune checkpoint inhibitors are used in treatment of advanced neoplasms. Immunotherapy agents create a potent pro-inflammatory effect in cancer. The efficacy of immunotherapy may negatively be impacted by the use of anti-inflammatory agents. An anti-inflammatory effect of cannabinoids has been described in literature in several models. Recent data suggests a negative impact of cannabis on tumor response to immunotherapy. Methods: We retrospectively reviewed medical records of all patients with metastatic cancer who received at least 2 months of immune checkpoint inhibitors between August 2014 and August 2018. The patients were stratified by use of cannabis (cannabis vs non-cannabis users). Baseline patients’ characteristics were compared. Overall survival was estimated and compared between the two groups. An analysis was performed using analysis of variance, Student’s t-test, correlation, chi-squared test, and logrank test. All data were analyzed with SPSS v. 26.0 and a p-value less than 0.05 was set to indicate statistical significance. Results: A total of 104 patients with advanced-stage malignancy met the inclusion criteria. The median age was 63.9±10.5 years, 48.1% males and 81.7% Caucasians. 41.3% of patients has lung adenocarcinoma, 20.3% has squamous cell carcinoma of the lung, 11.5% has squamous cell carcinoma of the head and neck and 26.9% have other tumor types. Twenty patients (19.2%) had brain metastasis and twenty-three patients (22.1%) had bone metastasis. Seventy patients (66.8%) received Nivolumab, and twenty-seven patients (26%) received Pembrolizumab. The mean duration of immunotherapy use was 10.2 months. Characteristics of patients were similar between the groups except for a higher prevalence of tobacco use in the cannabis group. Twenty-eight patients (26.9%) reported concomitant cannabis use during immunotherapy treatment, 23 were prescribed (dronabinol) and 5 used it recreationally (smoking marijuana/cannabis oil). Non-cannabis users had significantly longer overall survival (OS) compared to cannabis users (40 months vs 16 months, p = 0.004). Conclusions: This study shows significant association between the use of cannabis during immunotherapy treatment and worse OS. This can be explained by an anti-inflammatory effect of cannabis, which may decrease response to immune checkpoint inhibitors. This observation should be further investigated in randomized trials. Health care professionals should be aware of the potentially harmful effect of cannabis on cancer care.

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Cannabis Reduces Response Rate to Immunotherapy for Cancer

Patients treated with cannabis demonstrated a reduced response rate to immunotherapy, investigators found.

Administering cannabis to patients with cancer undergoing immunotherapy may lower the response rate to therapy without having an effect on progression-free survival (PFS) or overall survival (OS), according to study findings presented at the European Society of Medical Oncology (ESMO) 2017 Congress.

Patients with cancer commonly receive immunotherapy to improve the body’s response to tumors but also receive cannabis for palliative purposes, which has been associated with immunosuppressive effects.

For this retrospective, observational study, researchers assessed the data collected from 140 patients with advanced melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC) who were treated with nivolumab. Eighty-nine patients received nivolumab alone, and 51 patients received cannabis in combination with nivolumab.

A multivariant model showed that the only significant factor that lowered the response rate to immunotherapy was cannabis; patients who received nivolumab alone achieved a response rate of 37.5% compared to 15.9% in patients who received the combination (odds ratio [OR], 3.13; 95% CI, 1.24-8.13; P =.016).

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PFS and OS were not affected by cannabis. Factors that affected PFS were metastases, smoking, and response to therapy. Factors that affected OS were smoking, hypertension, disease progression, low performance score, and brain metastases.

The study authors concluded by saying, “This information can be critical for a large group of patients, and requires caution when starting immunotherapy. Considering the limitations of the study, further prospective clinical study is needed to investigate possible interaction.”

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1. Taha T, Talhamy S, Wollner M, et al. The effect of cannabis use on tumor response to nivolumab in patients with advanced malignancies. Oral presentation at: ESMO 2017 Congress; September 8-12, 2017; Madrid, Spain. Abstract 1545PD.

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