Therapeutic potential and pharmacological mechanisms of cannabinoids in alleviating chemotherapy-induced organ toxicity and adverse effects

Chemotherapeutic agent-induced organ toxicities, including cardiotoxicity, nephrotoxicity, hepatotoxicity, and neurotoxicity, remain significant challenges in cancer treatment, often limiting therapeutic utility, effectiveness and patient quality of life (QOL). These toxicities arise from numerous mechanisms such as oxidative stress, inflammation, and apoptosis, driven by chemotherapeutic agents like doxorubicin, cisplatin, cyclophosphamide, and methotrexate. Various strategies are being explored to mitigate these toxicities without compromising the effectiveness of the treatment. Polypharmacological or dual-targeting agents that combat cancer cells, sensitize resistant cancer types, and minimize organ damage show enormous promise in therapeutics. Among emerging therapeutic targets, the endocannabinoid system, comprising cannabinoid receptors and metabolizing enzymes, offers potential in both cancer chemotherapy and reducing organ toxicities. The therapeutic potential of cannabinoids is attributed to their role in modulating inflammation, oxidative stress, and cell survival which are the common components of cancer pathogenesis and organ toxicities. Preclinical studies demonstrate that cannabinoid receptor-agonists, such as JWH-133 and beta-caryophyllene, mitigate organ damage by suppressing pro-inflammatory cytokines, reducing reactive oxygen species (ROS) production, and inhibiting apoptotic pathways. For instance, cannabinoid receptor 2 (CB2) activation has been shown to attenuate doxorubicin-induced cardiotoxicity by enhancing antioxidant defenses and reducing myocardial inflammation. Similarly, in cisplatin-induced nephrotoxicity, cannabinoids alleviate renal injury by decreasing tubular cell apoptosis and inflammatory infiltrates. Despite these promising findings, challenges remain, including the development of highly selective cannabinoid receptor agonists, understanding tissue-specific responses, and addressing translational gaps between animal models and human pathophysiology. This review highlights the mechanistic overview of cannabinoid receptor agonists in mitigating chemotherapy-induced organ toxicities and adverse effects, summarizes preclinical evidence, and discusses the potential for clinical application. By elucidating the therapeutic potential of the activation of cannabinoid receptors, this work underscores its viability as a novel strategy to enhance the effectiveness of chemotherapeutic regimens and improve patient outcomes, however, further research is the need of the hour to advance cannabinoid-mediated therapies into clinical practice.