Mucositis

One of the side effects of conventional cancer treatment with chemotherapy is damage to healthy tissue, which often leads to a breakdown of the mucosal barrier of the gastrointestinal tract, known as mucositis. This is due to rapid and extensive DNA damage in highly proliferative stem cells throughout the gastrointestinal mucosa. The resulting cell death and inflammation leads to the breakdown of the mucosa and the formation of lesions in the mouth, esophagus, intestines and rectum. This leads to changes in taste, dysphagia, pain and malabsorption, which in turn leads to anorexia, malnutrition and dehydration. The resulting gaps in the protective mucosa create an unfavorable environment for the resident intestinal bacteria. This leads to a further weakening of the mucosal barrier. Fever, cognitive impairment and fatigue can be the result.

The role of the endocannabinoid system

Medicinal cannabis contains compounds such as cannabinoids, including cannabidiol (CBD) and tetrahydrocannabinol (THC), which interact with the body’s endocannabinoid system. This regulates a number of functions known to be negatively affected by chemotherapy, including mood, anxiety, cognition, appetite, sleep and pain. Gastrointestinal inflammation, mucosal defense and gastric motility, including diarrhea and constipation, also play a role. Given the immunomodulatory ability of the ECS, many symptoms and side effects of chemotherapy can be influenced by the ECS.

Previous use of medicinal cannabis in cancer

There are already numerous studies on the use of medicinal cannabis in cancer treatment. Pain is the most commonly reported symptom. Nausea, vomiting, loss of appetite, sleep disturbances and psychological symptoms (depression, anxiety) also play a major role. New findings show the possible role of cannabis in these side effects caused by chemotherapy. CBD and THC in particular are being studied intensively for their ability to influence the function of the gastrointestinal tract. This is due to the fact that the endocannabinoid system (ECS) controls gastrointestinal homeostasis to a significant degree. CNR1 and CNR2, G-protein-coupled receptors present in the gastrointestinal tract, are responsible for this. This network of ECS receptors controls gastric motility.

Medicinal cannabis – use during active cancer treatment

According to the study reviewed for this article [1], medical cannabis should be used during active chemotherapy to minimize both the depth and duration of mucositis. It is important to point out that much of the evidence for the use of medicinal cannabis in cancer has only been studied in vitro or in preclinical (animal) models.

However, there are also human clinical trials investigating the role of cannabinoids in the active treatment of cancer. The results of these studies show that in the standard treatment of recurrent high-grade glioma, the addition of medical cannabis resulted in an improvement in quality of life and imaging-indicated tumor response in 11% of patients, while in 34% of patients, disease progression remained stable compared to previous controls. These clinical trials make it clear that some patients may benefit from treatment with cannabinoids.
However, there are currently no predictive biomarkers to identify responders and non-responders.

Although the use of medicinal cannabis during active chemotherapy still presents some challenges, including drug interactions, there are also potential benefits and opportunities that have been highlighted in these studies. The focus of medical cannabis adjunctive therapy is on combating the development of some symptoms or controlling these symptoms at an early stage.

Targeted adjunctive treatment with medicinal cannabis for mucositis may have the following benefits:

• Medicinal cannabis can influence eating behavior in weight loss due to reduced oral food intake (anorexia) through taste changes and pain (appetite stimulant) in a way that can have a positive effect on weight maintenance and nutritional status.
• Sleep disturbances due to diarrhea and pain. Due to the pain-relieving properties of medicinal cannabis, targeted treatment has the potential to improve patients’ quality of life.
• Anti-inflammatory properties of medicinal cannabis.

For mucositis, the use of CBD and THC (along with other cannabinoids and compounds such as terpenes) is probably best suited to provide meaningful benefits due to their synergistic effects. CBD has been shown to counteract the (undesirable) psychotropic effects of THC, while THC can, for example, help with anxiety or promote food intake/appetite and sleep quality.

Conclusion

Given the numerous symptoms that occur as a secondary consequence of mucosal barrier impairment in mucositis, the use of medical cannabis as an adjunctive therapy has the potential to alleviate certain symptoms and improve quality of life for individuals during active cancer treatment.
Further studies are needed to better understand the specific effects of medical cannabis on gut health in people with advanced cancer and to validate the efficacy and safety of this treatment option.

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