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Study breakdown

Very little is known about how cannabis is absorbed and metabolized in cancer patients

Systematic ReviewPreliminary evidence
The takeaway

A systematic review of medicinal cannabis pharmacology in oncology found only 18 relevant studies and virtually no data on absorption in cancer populations, revealing a critical gap in dosing knowledge.

Oncologists, pharmacologists, and cancer patients using medicinal cannabis.

Only 4 studies had absorption data

What the researchers found

Of 18 selected articles (10 RCTs, 2 experimental, 2 retrospective cohort, 4 case studies), only 4 reported absorption data and only 1 drug interaction study was identified. There is almost no evidence on the pharmacokinetics of medicinal cannabis specifically in cancer patients.

Why it matters

Without absorption data, cannabis dosing in cancer patients is essentially guesswork. Cancer patients may metabolize cannabinoids differently due to their disease, other medications, and compromised organ function, making this gap particularly dangerous.

The numbers in context

18 articles selected: 10 RCTs, 2 experimental, 2 retrospective cohort, 4 case studies. Only 4 reported absorption data. Only 1 drug interaction study found.

How the study worked

Systematic literature review across six databases for studies reporting pharmacological data on medicinal cannabis in oncology.

What this study cannot tell us

Systematic review can only identify what has been studied. The lack of pharmacokinetic data may partly reflect the difficulty of conducting such studies in cancer populations and the challenges of cannabinoid analytical methods.

How to read the evidence

Rated preliminary because the review reveals a near-total absence of pharmacokinetic evidence rather than providing positive findings.

When this study was published

Published in 2019. Some additional pharmacokinetic research may have been conducted since.

The bigger picture

Cannabis is increasingly used by cancer patients, but the pharmaceutical basics, how much gets absorbed, how it interacts with chemotherapy, and how disease state affects metabolism, are almost entirely unknown. This is remarkable for a substance used by millions of patients.

Questions still open

  • How do cancer-related changes in liver and GI function affect cannabis absorption? What are the drug interactions between cannabinoids and common chemotherapy regimens? Should dosing be adjusted based on cancer type or treatment?

Common questions

Do we know how cannabis works in cancer patients?
Barely. This review found almost no data on how cannabis is absorbed in cancer patients, meaning dosing recommendations lack a pharmacological foundation.
Why is this gap important?
Cancer patients often have altered metabolism from disease and treatment. Without knowing how cannabinoids are absorbed and processed in this population, effective and safe dosing cannot be determined.

Read the original research

Pharmacological evidence of medicinal cannabis in oncology: a systematic review.

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 27(9), 3195-3207

Citation

Brown, Danielle; Watson, Michael; Schloss, Janet. (2019). Pharmacological evidence of medicinal cannabis in oncology: a systematic review.. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 27(9), 3195-3207. https://doi.org/10.1007/s00520-019-04774-5

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