Cannabidiol for Preventing Oxaliplatin Induced Neuropathy in Locally Advanced Unresectable or Metastatic Colorectal Cancer Patients

Inclusion Criteria

• Age >= 18 years and ability to provide informed consent
• Patients with metastatic, locally advanced unresectable colorectal cancer patients planned to receive Ox based chemotherapy in metastatic setting (at least 3 months planned)
• Subjects are allowed to have one cycle of Ox based chemotherapy before enrollment
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2
• No prior platinum exposure
• No evidence of ongoing neuropathy of any grade at the time of enrollment
• Patients must have marrow and organ function appropriate for systemic therapy, as per physician discretion
• Total bilirubin: Less than and/or equal to 1.5 x upper limit of normal (ULN)
• Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT)(serum glutamic pyruvic transaminase [SGPT]): Less than and/or equal to 3 x ULN (5 x ULN in patients with liver metastases
• Ability to understand and willingness to sign a written informed consent and Health Insurance Portability and Accountability Act (HIPAA) consent document

Exclusion Criteria

• Family history of genetic/familial neuropathy and personal history of ongoing neuropathy (any grade) or nervous system disease with the potential to affect cognition, Parkinson’s disease, or multiple sclerosis
• Routine use of recreational marijuana products (defined as > 4 times per month) or illicit drug use per self-reported history within the last 90 days. If using medical cannabis products, it should be stopped at least 1 week prior to inclusion
• Known underlying liver disease (Child-Pugh B or C) or baseline elevation of total bilirubin greater than and/or equal to 1.5 x upper limit of normal based on screening laboratory values
• Untreated brain metastases (can increase seizure risk), or treated brain metastases on anti-seizure medications
• Patients being treated with anti-seizure or anti-psychotic medications. Patients with a prior history of anti-seizure medication use, who have been off treatment for more than 3 months, are eligible. Use of selective serotonin reuptake inhibitors (SSRIs) is permitted
• Concomitant treatment with strong inducers of CYP3A4 and/or strong inducers of CYP2C19
• Underlying history of epilepsy/recurrent seizure disorder or unexplained seizure within past 6 months
• Patients with current or lifetime diagnosis of schizophrenia spectrum disorder, psychotic disorder, bipolar disorder type I & II, cluster B personality disorders (antisocial, borderline, narcissistic, histrionic), eating disorders, as defined by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revised (DSM-5-TR, American Psychiatric Association [APA] 2022)
• Recent history or clinical concern for major depression with suicidal ideation as determined by investigator assessment at baseline
• Currently taking medications known to be contraindicated with Epidiolex-Food and Drug Administration (FDA) approved CBD (buprenorphine, leflunomide, levomethadyl acetate, lomitapide, mipomersen, pexidartinib, propoxyphene, sodium oxybate, teriflunomide, clobazam, lamotrigine, valproate)
• Women who are pregnant or breastfeeding, and individuals of any sex who are capable of reproduction and unwilling to use an effective form of birth control (e.g., condoms, diaphragm, birth control pills, or intrauterine device [IUD])
• Patients may not be receiving any other investigational agents