CANNABINOIDS AND THE ENDOCANNABINOID SYSTEM IN ONCOLOGY: FROM SUPPORTIVE CARE TO EMERGING ANTICANCER STRATEGIES

Vollständiger Abstract

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Background The endocannabinoid system (ECS) regulates key physiological processes involved in pain, appetite, mood, immune function, and tumor biology, supporting growing interest in cannabinoids in supportive oncology and experimental anticancer research. Aim This narrative review critically evaluates current clinical, preclinical, and translational evidence on cannabinoids and the ECS in oncology, with a clear distinction between clinically supported applications in supportive cancer care and experimental data on possible anticancer mechanisms. Materials and Methods A structured literature search was conducted up to May 24, 2026, using PubMed as the primary database and Google Scholar as a supplementary source. Out of 721 identified records, 183 peer-reviewed publications were included in the narrative synthesis. Results Current clinical evidence most strongly supports the use of cannabinoid-based therapies for chemotherapy-induced nausea and vomiting. Evidence for cancer-related pain, appetite stimulation, sleep disturbances, fatigue, anxiety, and depression remains limited, heterogeneous, and patient-dependent. Preclinical studies indicate that cannabinoid signaling may influence tumor-related processes, including apoptosis, autophagy, angiogenesis, invasion, tumor microenvironment modulation, and immune regulation; however, robust clinical evidence demonstrating anticancer efficacy in humans is lacking. Cannabinoid-based therapies are also associated with dose-dependent adverse effects and clinically relevant CYP450-mediated drug-drug interactions, particularly in oncology patients receiving polypharmacy. Conclusions Cannabinoids currently have their most clearly supported role in supportive oncology, especially in the management of chemotherapy-induced nausea and vomiting. Their possible anticancer effects remain predominantly preclinical and do not support the use of cannabinoids as standard anticancer therapy in humans. Clinical use requires careful consideration of safety risks, drug-drug interactions, and individual patient characteristics.