{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T23:31:32Z","timestamp":1787614292315,"version":"build-2736575974"},"reference-count":45,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T00:00:00Z","timestamp":1598572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Israel Ministry of health","award":["3000015198"],"award-info":[{"award-number":["3000015198"]}]}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Cancers"],"abstract":"<jats:p>Cannabis or its derivatives are widely used by patients with cancer to help with cancer symptoms and treatment side effects. However, cannabis has potent immunomodulatory properties. To determine if cannabis consumption during immunotherapy affects therapy outcomes, we conducted a prospective observatory study including 102 (68 immunotherapy and 34 immunotherapy plus cannabis) consecutive patients with advanced cancers who initiated immunotherapy. Cannabis consumption correlated with a significant decrease in time to tumor progression and overall survival. On the other hand, the use of cannabis reduced therapy-related immune-related adverse events. We also tested the possibility that cannabis may affect the immune system or the tumor microenvironment through the alteration of the endocannabinoid system. We analyzed a panel of serum endocannabinoids (eCBs) and eCB-like lipids, measuring their levels before and after immunotherapy in both groups. Levels of serum eCBs and eCB-like lipids, before immunotherapy, showed no significant differences between cannabis users to nonusers. Nevertheless, the levels of four eCB and eCB-like compounds were associated with patients\u2019 overall survival time. Collectively, cannabis consumption has considerable immunomodulatory effects, and its use among cancer patients needs to be carefully considered due to its potential effects on the immune system, especially during treatment with immunotherapy.<\/jats:p>","DOI":"10.3390\/cancers12092447","type":"journal-article","created":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T09:17:08Z","timestamp":1598606228000},"page":"2447","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":131,"title":["Cannabis Consumption Used by Cancer Patients during Immunotherapy Correlates with Poor Clinical Outcome"],"prefix":"10.3390","volume":"12","author":[{"given":"Gil","family":"Bar-Sela","sequence":"first","affiliation":[{"name":"Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel"},{"name":"Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 320002, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6933-9385","authenticated-orcid":false,"given":"Idan","family":"Cohen","sequence":"additional","affiliation":[{"name":"Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Campisi-Pinto","sequence":"additional","affiliation":[{"name":"The Laboratory of Cancer Biology and Cannabinoid Research, Department of Biology, Technion-Israel Institute of Technology, Haifa 320003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8696-8677","authenticated-orcid":false,"given":"Gil M.","family":"Lewitus","sequence":"additional","affiliation":[{"name":"The Laboratory of Cancer Biology and Cannabinoid Research, Department of Biology, Technion-Israel Institute of Technology, Haifa 320003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lanuel","family":"Oz-Ari","sequence":"additional","affiliation":[{"name":"Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 320002, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayellet","family":"Jehassi","sequence":"additional","affiliation":[{"name":"Statistic unit, Emek Medical Center, Afula 1834111, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avivit","family":"Peer","sequence":"additional","affiliation":[{"name":"Division of Oncology, Rambam Health Care Campus, Haifa 320002, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4123-1107","authenticated-orcid":false,"given":"Ilit","family":"Turgeman","sequence":"additional","affiliation":[{"name":"Division of Oncology, Rambam Health Care Campus, Haifa 320002, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Vernicova","sequence":"additional","affiliation":[{"name":"Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6821-3307","authenticated-orcid":false,"given":"Paula","family":"Berman","sequence":"additional","affiliation":[{"name":"The Laboratory of Cancer Biology and Cannabinoid Research, Department of Biology, Technion-Israel Institute of Technology, Haifa 320003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Wollner","sequence":"additional","affiliation":[{"name":"Division of Oncology, Rambam Health Care Campus, Haifa 320002, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mor","family":"Moskovitz","sequence":"additional","affiliation":[{"name":"Division of Oncology, Rambam Health Care Campus, Haifa 320002, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Meiri","sequence":"additional","affiliation":[{"name":"The Laboratory of Cancer Biology and Cannabinoid Research, Department of Biology, Technion-Israel Institute of Technology, Haifa 320003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e697","DOI":"10.3389\/fpls.2019.00697","article-title":"Legal and regulatory issues governing cannabis and cannabis-derived products in the United States","volume":"10","author":"Mead","year":"2019","journal-title":"Front. 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