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Original research
Medical cannabis and its effect on oncological outcomes in patients with ovarian cancer treated with PARP inhibitors
  1. Shira Peleg Hasson1,2,
  2. Eliya Shachar1,2,
  3. Miriam R Brezis1,2,
  4. Akram Saad1,3,
  5. Bar Toledano1,
  6. Nadav Michaan1,4,
  7. Ido Laskov1,4,
  8. Dan Grisaru1,4,
  9. Jeffrey Goldstein5,
  10. Amir Nutman6,7 and
  11. Tamar Safra1,2
  1. 1 Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  2. 2 Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  3. 3 Sheba Cancer Center and Institute of Oncology, Tel Hashomer, Tel Aviv, Israel
  4. 4 Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  5. 5 Department of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  6. 6 Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  7. 7 Edith Wolfson Medical Center, Holon, Israel
  1. Correspondence to Dr Shira Peleg Hasson, Faculty of Medicine, Tel Aviv University, Tel Aviv, Tel Aviv, Israel; shiraph{at}tlvmc.gov.il

Abstract

Background Poly (ADP-ribose) polymerase inhibitors (PARPi) play a pivotal role in ovarian cancer management. With medical cannabis emerging as a novel component of supportive care, this study investigated the impact of medical cannabis use on oncological outcomes in patients with ovarian cancer undergoing PARPi therapy.

Methods The study included patients from a single institution database treated for ovarian cancer between January 2014 and January 2020 who received PARPi maintenance therapy in a first-line or recurrent disease setting after a confirmed response to platinum-based treatment. The study categorized patients as cannabis users and cannabis-naïve. Univariate and multivariate Cox regression analysis and the Kaplan–Meier method were used to assess the effects of medical cannabis use on the duration of PARPi therapy, progression-free survival, and overall survival.

Results Among the eligible patients (n=93), most were cannabis-naïve (69%, n=64) while the rest used medical cannabis (31%, n=29). Medical cannabis use rates were comparable for patients receiving PARPi therapy post-primary treatment or for recurrence (42%, n=9, vs 27%, n=20; p=0.1). Both groups exhibited similar median duration for PARPi therapy (12.1 vs 9.5 months; p=0.89) and progression-free survival (20 vs 21 months; p=0.83). Kaplan–Meier analysis detected no differences in progression-free survival associated with cannabis use. Although cannabis users had an extended overall survival compared with the cannabis-naïve group (129.3 vs 99 months; p=0.03), cannabis use was insignificant for overall survival on multivariate analysis (p=0.10). Multivariate analysis showed stage IV at diagnosis (p=0.02) to be the sole factor associated with progression-free survival (p=0.02).

Conclusion Medical cannabis usage in patients receiving PARPi treatment showed no association with duration of PARPi therapy, progression-free survival, or overall survival.

  • ovarian cancer
  • BRCA1 protein
  • BRCA2 protein
  • quality of life (PRO)/palliative care

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/ijgc-2023-004953

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors SPH designed the data collection tools, monitored the data collection for the whole trial, wrote the statistical analysis plan, cleaned and analysed the data, and drafted and revised the paper. SPH is responsible for the overall content as guarantor.

      BT collected data. JG analysed the data and drafted and revised the paper. AN assisted with the statistical analysis plan and revised the paper. All other authors revised the draft paper.

    • Funding We wish to thank the Parasol Family Foundation for providing an unrestricted grant for fellowship training to SPH.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.