Pathogenesis, Assessments, and Management of Chemotherapy-Related Cognitive Impairment (CRCI): An Updated Literature Review

Lv, Longqin; Mao, Shanping; Dong, Hongyan; Hu, Pan; Dong, Ruochen

doi:10.1155/2020/3942439

Cited by 45 publications

(53 citation statements)

References 122 publications

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“…As stated above, the mechanism by which taxanes cause PN is not fully elucidated, although axonal damage has been identified in some studies. Chemotherapy-related cognitive impairment (CRCI) is another side effect of chemotherapy whose etiology is not well identified but appears to be related to impaired white matter integrity [ 44 ]. Moreover, neuroinflammation seems to be another possible explanatory mechanism for cognitive impairment and peripheral neuropathy, as highlighted both in clinical and animal studies [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Association between Low-Grade Chemotherapy-Induced Peripheral Neuropathy (CINP) and Survival in Patients with Metastatic Adenocarcinoma of the Pancreas

Catalano

Aprile

Ramello

et al. 2021

JCM

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The combination of nab-paclitaxel and gemcitabine demonstrated greater efficacy than gemcitabine alone but resulted in higher rates of chemotherapy-induced peripheral neuropathy (CINP) in patients with metastatic pancreatic cancer (mPC). We aimed to evaluate the correlation between the development of treatment-related peripheral neuropathy and the efficacy of nab-P/Gem combination in these patients. mPC patients treated with nab-paclitaxel 125 mg/m2 and gemcitabine 1000 mg/m2 as a first-line therapy were included. Treatment-related adverse events, mainly peripheral neuropathy, were categorized using the National Cancer Institute Common Toxicity Criteria scale, version 4.02. Efficacy outcomes, including overall survival (OS), progression-free survival (PSF), and disease control rate (DCR), were estimated by the Kaplan–Meier model. A total of 153 patients were analyzed; of these, 47 patients (30.7%) developed grade 1–2 neuropathy. PFS was 7 months (95% CI (6–7 months)) for patients with grade 1–2 neuropathy and 6 months (95% CI (5–6 months)) for patients without peripheral neuropathy (p = 0.42). Median OS was 13 months (95% CI (10–18 months)) and 10 months (95% CI (8–13 months)) in patients with and without peripheral neuropathy, respectively (p = 0.04). DCR was achieved by 83% of patients with grade 1–2 neuropathy and by 58% of patients without neuropathy (p = 0.03). In the multivariate analysis, grade 1–2 neuropathy was independently associated with OS (HR 0.65; 95% CI, 0.45–0.98; p = 0.03). nab-P/Gem represents an optimal first-line treatment for mPC patients. Among possible treatment-related adverse events, peripheral neuropathy is the most frequent, with different grades and incidence. Our study suggests that patients experiencing CINP may have a more favorable outcome, with a higher disease control rate and prolonged median survival compared to those without neuropathy.

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Section: Discussionmentioning

confidence: 99%

Association between Low-Grade Chemotherapy-Induced Peripheral Neuropathy (CINP) and Survival in Patients with Metastatic Adenocarcinoma of the Pancreas

Catalano

Aprile

Ramello

et al. 2021

JCM

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“…A growing evidence base supports the lasting impact of cancer and its treatment on cognitive function [5][6][7][8] . Cognitive functions typically affected are memory, attention, executive function, and processing speed 9 , resulting in negative impacts on quality of life 10 .…”

Section: Cognition and Cancermentioning

confidence: 99%

“…In addition to specifying treatment regimen, cancer type, gender, age at diagnosis, time since end of active treatment, and comorbidities, studies of cognitive function should characterize risk factors associated with lower cognitive function such as PTSD, fatigue, and childhood trauma and stress 7,21,65,66 . This is particularly important as PTSD and fatigue are highly prevalent in AYA cancer survivors.…”

Section: Well-characterized Participant Samples and Control Groupsmentioning

confidence: 99%

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Cancer-related cognitive impairment in survivors of adolescent and young adult cancer: A scoping review

Vizer

Mikles²,

Piepmeier³

2021

Preprint

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Objectives: Cancer-related cognitive impairments (CRCI) are common after treatment and could have importantrepercussions for adolescent and young adult (AYA) survivors diagnosed between ages 15 and 39. However, mostresearch focuses on younger or older survivors so we know relatively little about CRCI among AYA cancer survivors.Here we review the research on CRCI among survivors of AYA cancer to determine prevalence, associated factors,and ongoing impact.Methods: In December 2020 we performed a systematic search in MEDLINE, Web of Science, PsycInfo, CINAHL,EMBASE, and Cochrane Central Register of Controlled Trials to identify peer-reviewed English language articlesdescribing original research with survivors of AYA cancer having at least one outcome concerning cognition. We screened 4090 articles and 35 met eligibility criteria. Guided by the PRISMA-ScR Checklist, we extractedinformation, assessed study quality, organized articles by study design, identified factors associated with CRCI, andidentified ongoing impacts of CRCI.Results: Most studies were cross-sectional surveys and interviews with some longitudinal and neurocognitiveassessment studies, one brain imaging study, and one intervention study. Weighted mean prevalence of CRCI was38.4%. Factors associated with CRCI included older age, female gender, higher dose chemotherapy, andcomorbidities. Ongoing impacts of CRCI included impaired role functioning, financial toxicity, and unmet needs.However, the intervention study had encouraging results for improving cognition and functioning.Conclusions: This review of literature on CRCI in survivors of AYA cancer shows a need for longitudinal, imaging,and intervention studies. Digital health technology is recommended for research and intervention implementation.

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“…Indeed, a randomized controlled trial found that 2 mg of prolonged (time-released) melatonin in Alzheimer's Disease patients improved cognitive function with significant reversal of circadian disruption [33]. Tellingly, from a variety of malignancies, we know that chemotherapy is neurotoxic and that there are both acute and delayed adverse side effects of chemotherapy on cognitive function, with the resulting cognitive impairment a source of considerable distress, compromising the patient's QoL -with as much as 75% of breast cancer patients affected [38] in part mediated by oxidative stress associated with chemotherapy and by decreased hippocampal volume and cytokine-mediated blood brain barrier disruption [38][39][40], with some of these contributory neuroinflammatory cascades being triggered in many cases both by the cancer itself as well as the chemotherapy regimens deployed. It is important to note that optimal dosing matters, this being set at 20 mg nightly [39], as witness an earlier RCT [41] that failed to find any effect of melatonin on cognitive function, but the difference being it dosed at 6 mg.…”

Section: Melatonin -Neurocognitive Impact and Issuesmentioning

confidence: 99%

Melatonin at the crossroads: Commentary on COVID and cognition

Kaniklidis¹

2020

Integr Cancer Sci Therap

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In this commentary, we explore the frontier edge of the emerging potential role of the chronobiotic agent melatonin, in both the prevention and treatment, and in the amelioration of some of the newly identified pathological neurocognitive sequelae, of SARS-2-CoV infection (COVID-19 disease). In the process we review clinical evidence of benefit in these domains, suggesting the strong promise that melatonin appears to provide, with a highly favorable benefit/harm ratio of excellent tolerability, affordability and safety, and sufficiently compelling evidence of efficacy as to be actionable, in the here and now.

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Pathogenesis, Assessments, and Management of Chemotherapy-Related Cognitive Impairment (CRCI): An Updated Literature Review

Cited by 45 publications

References 122 publications

Association between Low-Grade Chemotherapy-Induced Peripheral Neuropathy (CINP) and Survival in Patients with Metastatic Adenocarcinoma of the Pancreas

Association between Low-Grade Chemotherapy-Induced Peripheral Neuropathy (CINP) and Survival in Patients with Metastatic Adenocarcinoma of the Pancreas

Cancer-related cognitive impairment in survivors of adolescent and young adult cancer: A scoping review

Melatonin at the crossroads: Commentary on COVID and cognition

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