Dose Response Relationship of Medical Cannabis and Symptom Control in Patients With Pancreatic Cancer: An Analysis of the CANPAN Trial.

Gupta A.; Lin K.; Chrenka E.; Gilmore G.; Cowger J.; Rak D.; Zylla D. · The oncologist · 2026

**Background & Methods** CANPAN is a pilot randomized controlled trial enrolling 32 cannabis-naïve patients with newly diagnosed locally advanced or metastatic pancreatic adenocarcinoma. Patients were randomized to early (weeks 0-8) or delayed (weeks 9-16) personalized medical cannabis intervention, with patient-reported outcomes (PROs) assessed at baseline and 8 weeks to evaluate dose-response relationships and symptom efficacy over 16 weeks. **Key Findings** - Cannabis use rates were 72% overall (12/16 early arm, 11/16 delayed arm), with median daily THC doses of 10 mg (early) and 9.3 mg (delayed) at 4 weeks post-initiation, demonstrating comparable dosing patterns across randomization arms. - Higher average daily THC dose showed dose-dependent improvements in anxiety (r=0.52, p=0.038) and insomnia (r=0.53, p=0.033), with THC ≥10 mg daily associated with mean improvement in 4 symptoms versus 2.1 symptoms at doses <10 mg. - At 16-week study completion, PRO data were available for 50% of participants (16/32), with longitudinal data retention challenges limiting full dose-response analysis across the extended follow-up period. **Dosage & Administration** Median daily THC dose was approximately 10 mg at 4 weeks after cannabis initiation. A threshold dose of ≥10 mg daily THC was associated with superior multi-symptom efficacy compared to doses <10 mg. Specific routes of administration and cannabidiol (CBD) dosing were not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This pilot RCT provides preliminary dose-response data in a small, cannabis-naïve population with advanced pancreatic cancer. Critical limitations include 50% PRO completion at 16 weeks, reducing statistical power and generalizability. The small sample size (n=32, with only 16 having complete paired data) limits confidence in dose-response correlations. As a pilot study with previously reported primary efficacy outcomes, this secondary analysis lacks a comparator arm at the 16-week timepoint and cannot establish causality. The waitlist-control design provides internal validity but precludes long-term safety assessment. Results should inform future trial design but require validation in larger, adequately powered studies with improved retention strategies.

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