Cannabinoids in the Treatment of Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review of Randomized Controlled Trials

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating toxicity of cancer treatment. Effective pharmacological treatments remain limited. Preclinical studies suggest cannabinoids reduce neuropathic pain through modulation of neurotransmission, neuroinflammation, and oxidative stress. However, clinical evidence in CIPN remains inconclusive. This systematic review evaluated the efficacy and safety of cannabis-based medicinal products (CBMPs) for the treatment or prevention of CIPN. A systematic search of PubMed MEDLINE, OVID EMBASE, and OVID MEDLINE was conducted to identify randomized controlled trials assessing CBMPs in adults with CIPN. Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers using Cochrane Risk of Bias 2. Of 1,115 records identified, three double-blind randomized controlled trials with 68 participants and three ongoing trials met inclusion criteria. Interventions included nabiximols, oral cannabidiol, and topical cannabidiol. No study demonstrated improvement in pain or health-related quality of life compared with placebo (p > 0.050). Adverse events were mild to moderate, most commonly fatigue, dizziness, and dry mouth. Heterogeneity in study design, outcome measures, and follow-up prevented meta-analysis. Current evidence is insufficient to support the routine use of CBMPs for CIPN. Larger, methodologically rigorous trials with standardized outcomes and longer follow-up are required.

Keywords: Cannabis; cancer; chemotherapy; neuropathy; pain.