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Mulholland MM, Stuifbergen A, De La Torre Schutz A, Franco Rocha OY, Blayney DW, Kesler SR. Evidence of compensatory neural hyperactivity in a subgroup of chemotherapy-treated breast cancer survivors and its association with brain aging. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.22.24306190. [PMID: 38712178 PMCID: PMC11071584 DOI: 10.1101/2024.04.22.24306190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Chemotherapy-related cognitive impairment (CRCI) remains poorly understood in terms of the mechanisms of cognitive decline. Neural hyperactivity has been reported on average in cancer survivors, but it is unclear which patients demonstrate this neurophenotype, limiting precision medicine in this population. We evaluated a retrospective sample of 80 breast cancer survivors and 80 non-cancer controls, age 35-73, for which we had previously identified and validated three data-driven, biological subgroups (biotypes) of CRCI. We measured neural activity using the z-normalized percent amplitude of fluctuation from resting state functional magnetic resonance imaging (MRI). We tested established, quantitative criteria to determine if hyperactivity can accurately be considered compensatory. We also calculated brain age gap by applying a previously validated algorithm to anatomic MRI. We found that neural activity differed across the three CRCI biotypes and controls (F = 13.5, p < 0.001), with Biotype 2 demonstrating significant hyperactivity compared to the other groups (p < 0.004, corrected), primarily in prefrontal regions. Alternatively, Biotypes 1 and 3 demonstrated significant hypoactivity (p < 0.02, corrected). Hyperactivity in Biotype 2 met several of the criteria to be considered compensatory. However, we also found a positive relationship between neural activity and brain age gap in these patients (r = 0.45, p = 0.042). Our results indicated that neural hyperactivity is specific to a subgroup of breast cancer survivors and, while it seems to support preserved cognitive function, it could also increase the risk of accelerated brain aging. These findings could inform future neuromodulatory interventions with respect to the risks and benefits of up or downregulation of neural activity.
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Affiliation(s)
- Michele M Mulholland
- Department of Comparative Medicine, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - Alexa Stuifbergen
- Division of Adult Health, School of Nursing, University of Texas at Austin, Austin, TX, USA
| | | | - Oscar Y Franco Rocha
- Division of Adult Health, School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Douglas W Blayney
- Department of Medical Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Shelli R Kesler
- Division of Adult Health, School of Nursing, University of Texas at Austin, Austin, TX, USA
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Cil T, Boileau JF, Chia S, DeCoteau MJ, Jerzak KJ, Koch A, Nixon N, Quan ML, Roberts A, Brezden-Masley C. The Canadian Breast Cancer Symposium 2023 Meeting Report. Curr Oncol 2024; 31:1774-1802. [PMID: 38668038 PMCID: PMC11049169 DOI: 10.3390/curroncol31040135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 04/28/2024] Open
Abstract
On 15-16 June 2023, healthcare professionals and breast cancer patients and advocates from across Canada met in Toronto, Ontario, for the 2023 Canadian Breast Cancer Symposium (CBSC.). The CBSC. is a national, multidisciplinary event that occurs every 2 years with the goal of developing a personalized approach to the management of breast cancer in Canada. Experts provided state-of-the-art information to help optimally manage breast cancer patients, including etiology, prevention, diagnosis, experimental biology, and therapy of breast cancer and premalignant breast disease. The symposium also had the objectives of increasing communication and collaboration among breast cancer healthcare providers nationwide and providing a comprehensive and real-life review of the many facets of breast cancer. The sessions covered the patient voice, the top breast cancer papers from different disciplines in 2022, artificial intelligence in breast cancer, systemic therapy updates, the management of central nervous system metastases, multidisciplinary management of ductal carcinoma in situ, special populations, optimization-based individual prognostic factors, toxicity management of novel therapeutics, survivorship, and updates in surgical oncology. The key takeaways of these sessions have been summarized in this conference report.
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Affiliation(s)
- Tulin Cil
- Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (T.C.); (A.K.)
| | | | - Stephen Chia
- British Columbia Cancer Centre, University of British Columbia, Vancouver, BC V5Z 4E6, Canada;
| | - MJ DeCoteau
- Rethink Breast Cancer, Toronto, ON M4M 3G3, Canada;
| | - Katarzyna J. Jerzak
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.J.J.); (A.R.)
| | - Anne Koch
- Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (T.C.); (A.K.)
| | - Nancy Nixon
- Department of Surgery and Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada; (N.N.); (M.L.Q.)
| | - May Lynn Quan
- Department of Surgery and Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada; (N.N.); (M.L.Q.)
| | - Amanda Roberts
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.J.J.); (A.R.)
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Wiranata JA, Hutajulu SH, Astari YK, Leo B, Bintoro BS, Hardianti MS, Taroeno-Hariadi KW, Kurnianda J, Purwanto I. Patient-reported outcomes and symptom clusters pattern of chemotherapy-induced toxicity in patients with early breast cancer. PLoS One 2024; 19:e0298928. [PMID: 38394281 PMCID: PMC10890761 DOI: 10.1371/journal.pone.0298928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE This study aims to characterize patient-reported chemotherapy-induced toxicity in patients with breast cancer, determine its association with treatment regimens and patient characteristics, identify toxicity symptom clusters within a specific chemotherapy timeframe and analyze the correlation between symptom clusters within and between the timeframe to understand the changes and influences across chemotherapy. METHODS Forty-six patient-reported toxicities during neoadjuvant/adjuvant chemotherapy for breast cancer were evaluated using adapted CTCAE version 4.0. Chi-Square/Fisher's Exact test was performed to analyze the difference in the incidence of toxicity symptoms by chemotherapy regimens. Poisson regression performed to assess factors associated with patient's total chemotherapy toxicity. Exploratory factor analysis (EFA) conducted to identify symptom clusters at T1 (first half) and T2 (second half of planned cycle). Factor scores were generated and Spearman correlation performed to explore the factor scores correlation between symptom clusters. RESULTS A total of 142 patients with stage I-III breast cancer were included. The incidence of several toxicities differed significantly among three chemotherapy regimens. Subjects age ≥51 years are associated with lower number of reported toxicity (IRR/incidence rate ratio = 0.94, 95% confidence interval/CI 0.88 to 0.99, p = 0.042). Receiving more chemotherapy cycles are associated with higher number of reported toxicity (IRR = 1.06, 95% CI 1.03 to 1.10, p<0.001). Two symptom clusters identified at T1 (psychoneurological-pain/PNP-T1 and gastrointestinal-psychological/GIP-T1 cluster) and three at T2 (psychoneurological-pain/PNP-T2, epithelial/EPI-T2, and gastrointestinal cluster/GI-T2), with moderate-strong positive correlation between PNP-T1 and GIP-T2 (p<0.001), PNP-T1 and PNP-T2 (p<0.001), and GIP-T1 and PNP-T2 (p<0.001). CONCLUSIONS This study investigated 46 patient-reported toxicities prospectively during adjuvant/neoadjuvant chemotherapy for early breast cancer. Anthracycline-taxane combination regimen had higher proportions of toxicity incidence. Subject's age and number of chemotherapy cycles significantly associated with total number of toxicity symptoms. Two symptom clusters at T1 and three at T2 were identified, with significant correlation between symptom clusters within and between chemotherapy timeframe.
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Affiliation(s)
- Juan Adrian Wiranata
- Clinical Epidemiology Study Program, Master of Clinical Medicine Postgraduate Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Academic Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susanna Hilda Hutajulu
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Yufi Kartika Astari
- Research Scholar, Division of Hematology and Medical Oncology, Department of Internal Medicine, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Benedreky Leo
- Specialty Program in Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bagas Suryo Bintoro
- Department of Health Behaviour, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center of Health Behaviour and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mardiah Suci Hardianti
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Kartika Widayati Taroeno-Hariadi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Johan Kurnianda
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ibnu Purwanto
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Hu J, Su A, Liu X, Tong Z, Jiang Q, Yu J. Effects of D-CAG chemotherapy regimen on cognitive function in patients with acute myeloid leukaemia: A resting-state functional magnetic resonance imaging study. Eur J Neurosci 2024; 59:119-131. [PMID: 37969020 DOI: 10.1111/ejn.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
Post-chemotherapy cognitive impairment, also known as 'chemobrain', is a common neurotoxic complication induced by chemotherapy, which has been reported in many cancer survivors who have undergone chemotherapy. In this study, we aimed to explore the effects of D-neneneba dicitabine, C-nenenebb cytarabine, A-aclamycin, G-granulocyte colony-stimulating factor (D-CAG) chemotherapy on cognitive function in patients with acute myeloid leukaemia (AML) and its possible central mechanisms. Twenty patients with AML and 25 matched healthy controls (HC) were enrolled in this study. The cognitive function of patients before and after D-CAG chemotherapy was evaluated by the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). The resting-state functional magnetic resonance imaging data were collected from all patients before and after chemotherapy intervention, as well as HC. Then, resting-state functional magnetic resonance imaging data were preprocessed using DPABI software package and regional homogeneity (ReHo) values of brain regions were calculated. Finally, ReHo values between groups were compared by Resting-State fMRI Data Analysis software package with t-tests and Alphasim method was performed for multiple comparison correction. Moreover, associations between ReHo values of altered brain regions and the scores of FACT-Cog were analysed by Pearson correlation. The total FACT-Cog scores and four factor scores of AML patients increased significantly after treatment. ReHo values showed no significant changes in patients before treatment when compared with HC. Compared with HC, ReHo values of the right middle frontal gyrus, inferior frontal gyrus (opercular part), middle occipital gyrus, and left praecuneus decreased significantly, while ReHo values of the left inferior temporal gyrus, right middle temporal gyrus, and hippocampus increased significantly in patients after treatment. Compared with patients before treatment, ReHo values decreased significantly in the right middle frontal gyrus, inferior frontal gyrus (opercular part), and middle and inferior occipital gyri of patients after treatment. In addition, ReHo values of the right inferior frontal gyrus (opercular part) were negatively correlated with the total scores of FACT-Cog and factor scores of perceived cognitive impairment in patients after treatment. There were also negative correlations between ReHo values of the right middle frontal gyrus and perceived cognitive impairment scores. The present study confirmed that D-CAG chemotherapy might cause impaired subjective self-reported cognitive functioning in AML patients, which might be related to the decreased function of certain regions in the right prefrontal lobe. These findings provided further understanding of the mechanisms involved in post-chemotherapy cognitive impairment and would help develop new therapeutic strategies for 'chemobrain' in AML patients.
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Affiliation(s)
- Jun Hu
- Department of Radiology, Nanjing Brain Hospital, Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ailing Su
- Department of Hematology, Nanjing First Hospital, Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xianwei Liu
- Department of Radiology, Nanjing Brain Hospital, Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhengrong Tong
- Department of Radiology, Nanjing Brain Hospital, Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qin Jiang
- Department of Radiology, Nanjing Brain Hospital, Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Yu
- Department of Radiology, Nanjing Brain Hospital, Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Hau SO, Svensson M, Petersson A, Eberhard J, Jirström K. Trajectories of immune-related serum proteins and quality of life in patients with pancreatic and other periampullary cancer: the CHAMP study. BMC Cancer 2023; 23:1074. [PMID: 37936126 PMCID: PMC10629201 DOI: 10.1186/s12885-023-11562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND There is still a profound lack of efficient therapeutic strategies against pancreatic and other periampullary adenocarcinoma. Surgery is seldom possible, leaving palliative chemotherapy the only option for most patients. Chemotherapy treatment is however often accompanied by serious side-effects, and the identification of biomarkers for early prediction of disease and treatment-associated symptoms could help alleviate patient suffering. This study investigated the dynamic interrelationship between immune-related serum proteins, routine biomarkers, and health-related quality of life (HRQoL) factors during chemotherapy treatment of patients enrolled in the prospective, observational study Chemotherapy, Host response And Molecular dynamics in Periampullary cancer (CHAMP). METHODS Proximity extension assay was applied to analyse 92 immune-associated proteins in longitudinal serum samples from 75 patients, 18 treated with curative and 57 with palliative intent. HRQoL data were available from all patients at baseline (BL), from 41 patients at three months, and from 23 patients at six months. Information on routine laboratory parameters albumin, CA19-9, CEA and CRP were collected from medical charts. RESULTS In total nine proteins; chemokine (C-C motif) ligand 23 (CCL23), cluster of differentiation 4 (CD4), cluster of differentiation 28 (CD28), decorin (DCN), galectin-1 (Gal-1), granzyme B (GZMB), granzyme H (GZMH), matrix metallopeptidase 7 (MMP7), and monocyte chemotactic protein-1 (MCP-1) were strongly correlated (Spearman's Rho ≤ -0.6 or ≥ 0.6) with either cognitive functioning (DCN), emotional functioning (DCN, MCP-1), dyspnoea (CD28, GZMB, GZMH) or insomnia (CCL23, CD4, Gal-1, MMP7) during treatment. Associations between routine laboratory parameters (CA 19-9, CA-125, CRP, CEA and albumin) and HRQoL factors were overall weaker. None of the investigated proteins were associated with pain. CONCLUSIONS This is, to our knowledge, the first study exploring associations between serum biomarkers and HRQoL in patients with pancreatic or other periampullary cancer, and some findings merit further validation. The associations of DCN and MCP-1with impaired cognitive and/or emotional functioning are of particular interest, given their established link to various neurodegenerative conditions. Chemotherapy is known to cause persistent cognitive dysfunction with effects on memory and executive function, referred to as "chemo brain". It would therefore be of great value to identify biomarkers for early detection and management of this debilitating condition. TRIAL REGISTRATION Clinical Trial Registration: NCT03724994.
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Affiliation(s)
- Sofie Olsson Hau
- Division of Oncology and Therapeutic Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Maja Svensson
- Division of Oncology and Therapeutic Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Alexandra Petersson
- Division of Oncology and Therapeutic Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jakob Eberhard
- Division of Oncology and Therapeutic Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Karin Jirström
- Division of Oncology and Therapeutic Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
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Pasquini L, Peck KK, Jenabi M, Holodny A. Functional MRI in Neuro-Oncology: State of the Art and Future Directions. Radiology 2023; 308:e222028. [PMID: 37668519 PMCID: PMC10546288 DOI: 10.1148/radiol.222028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 09/06/2023]
Abstract
Since its discovery in the early 1990s, functional MRI (fMRI) has been used to study human brain function. One well-established application of fMRI in the clinical setting is the neurosurgical planning of patients with brain tumors near eloquent cortical areas. Clinical fMRI aims to preoperatively identify eloquent cortices that serve essential functions in daily life, such as hand movement and language. The primary goal of neurosurgery is to maximize tumor resection while sparing eloquent cortices adjacent to the tumor. When a lesion presents in the vicinity of an eloquent cortex, surgeons may use fMRI to plan their best surgical approach by determining the proximity of the lesion to regions of activation, providing guidance for awake brain surgery and intraoperative brain mapping. The acquisition of fMRI requires patient preparation prior to imaging, determination of functional paradigms, monitoring of patient performance, and both processing and analysis of images. Interpretation of fMRI maps requires a strong understanding of functional neuroanatomy and familiarity with the technical limitations frequently present in brain tumor imaging, including neurovascular uncoupling, patient compliance, and data analysis. This review discusses clinical fMRI in neuro-oncology, relevant ongoing research topics, and prospective future developments in this exciting discipline.
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Affiliation(s)
- Luca Pasquini
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
| | - Kyung K. Peck
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
| | - Mehrnaz Jenabi
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
| | - Andrei Holodny
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
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Fleming B, Edison P, Kenny L. Cognitive impairment after cancer treatment: mechanisms, clinical characterization, and management. BMJ 2023; 380:e071726. [PMID: 36921926 DOI: 10.1136/bmj-2022-071726] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Cognitive impairment is a debilitating side effect experienced by patients with cancer treated with systemically administered anticancer therapies. With around 19.3 million new cases of cancer worldwide in 2020 and the five year survival rate growing from 50% in 1970 to 67% in 2013, an urgent need exists to understand enduring side effects with severe implications for quality of life. Whereas cognitive impairment associated with chemotherapy is recognized in patients with breast cancer, researchers have started to identify cognitive impairment associated with other treatments such as immune, endocrine, and targeted therapies only recently. The underlying mechanisms are diverse and therapy specific, so further evaluation is needed to develop effective therapeutic interventions. Drug and non-drug management strategies are emerging that target mechanistic pathways or the cognitive deficits themselves, but they need to be rigorously evaluated. Clinically, consistent use of objective diagnostic tools is necessary for accurate diagnosis and clinical characterization of cognitive impairment in patients treated with anticancer therapies. This should be supplemented with clinical guidelines that could be implemented in daily practice. This review summarizes the recent advances in the mechanisms, clinical characterization, and novel management strategies of cognitive impairment associated with treatment of non-central nervous system cancers.
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Affiliation(s)
- Ben Fleming
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Paul Edison
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Laura Kenny
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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Liu P, Guo L, Yu X, Liu P, Yu Y, Kong X, Yu X, Zephania HM, Liu P, Huang Y. Identification of region-specific amino acid signatures for doxorubicin-induced chemo brain. Amino Acids 2023; 55:325-336. [PMID: 36604337 DOI: 10.1007/s00726-022-03231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023]
Abstract
Doxorubicin (DOX) is a cornerstone of chemotherapy for solid tumors and leukemias. DOX-induced cognitive impairment, termed chemo brain, has been reported in cancer survivors, whereas its mechanism remains poorly understood. Here we initially evaluated the cognitive impairments of mice treated with clinically relevant, long-term, low-dosage of DOX. Using HILIC-MS/MS-based targeted metabolomics, we presented the changes of 21 amino acids across six anatomical brain regions of mice with DOX-induced chemo brain. By mapping the altered amino acids to the human metabolic network, we constructed an amino acid-based network module for each brain region. We identified phenylalanine, tyrosine, methionine, and γ-aminobutyric acid as putative signatures of three regions (hippocampus, prefrontal cortex, and neocortex) highly associated with cognition. Relying on the reported mouse brain metabolome atlas, we found that DOX might perturb the amino acid homeostasis in multiple brain regions, similar to the changes in the aging brain. Correlation analysis suggested the possible indirect neurotoxicity of DOX that altered the brain levels of phenylalanine, tyrosine, and methionine by causing metabolic disorders in the liver and kidney. In summary, we revealed the region-specific amino acid signatures as actionable targets for DOX-induced chemo brain, which might provide safer treatment and improve the quality of life among cancer survivors.
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Affiliation(s)
- Peijia Liu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China
| | - Linling Guo
- Department of Pharmaceutical Analysis, School of Pharmacy, China Pharmaceutical University, 24 Tongjia Lane, Nanjing, 210009, China
| | - Xinyue Yu
- Department of Pharmaceutical Analysis, School of Pharmacy, China Pharmaceutical University, 24 Tongjia Lane, Nanjing, 210009, China
| | - Peipei Liu
- Department of Pharmacology, School of Pharmacy, Harbin Medical University, 157 Baojian Road, Harbin, 150001, China
| | - Yan Yu
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China
| | - Xiaotong Kong
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China
| | - Xiaxia Yu
- Department of Pharmacy, Affiliated Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjia Bridge, Nanjing, 210009, China
| | - Hove Mzingaye Zephania
- Department of Pharmaceutical Analysis, School of Pharmacy, China Pharmaceutical University, 24 Tongjia Lane, Nanjing, 210009, China
| | - Peifang Liu
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China.
| | - Yin Huang
- Department of Pharmaceutical Analysis, School of Pharmacy, China Pharmaceutical University, 24 Tongjia Lane, Nanjing, 210009, China.
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Henneghan AM, Kesler SR. Subjective cancer-related cognitive impairments and salience network connectivity in breast cancer survivors. J Cancer Surviv 2022:10.1007/s11764-022-01307-8. [PMID: 36464750 PMCID: PMC10239781 DOI: 10.1007/s11764-022-01307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Little is known about the neural basis of subjective cancer-related cognitive changes. The purpose of this study was to explore salience network connectivity in relation to subjective executive and memory dysfunction in breast cancer survivors compared to controls. METHODS A retrospective cross-sectional analysis of neuroimaging, subjective cognitive, clinical, and demographic data in chemotherapy-treated primary breast cancer survivors compared to frequency matched controls was used. Functional connectivity within salience network hubs (anterior cingulate, bilateral insula) was determined using resting state functional MRI. Mann-Whitney U tests were used to evaluate group differences and Spearman's rho correlations were examined among the behavioral measures and salience network connectivity. RESULTS We included 65 breast cancer survivors and 71 controls. Survivors demonstrated greater subjective executive dysfunction and memory complaints (p < .001) and lower salience network connectivity (p < .05) than controls. Executive functioning correlated with bilateral insula and left anterior cingulate connectivity (rho > - 0.29, p < .05). Distress did not correlate with salience network connectivity. CONCLUSION These findings suggest that salience network connectivity may represent a biomarker of subjective cancer-related cognitive changes. IMPLICATIONS FOR CANCER SURVIVORS Subjective cancer-related cognitive changes are common following treatment and associated with objective changes in brain connectivity.
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Affiliation(s)
- Ashley M Henneghan
- School of Nursing, University of Texas at Austin, 1710 Red River St, D0100, Austin, TX, 78712, USA
- Department of Oncology, Dell School of Medicine, University of Texas at Austin, Austin, TX, 78712, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, 1710 Red River St, D0100, Austin, TX, 78712, USA.
- Department of Oncology, Dell School of Medicine, University of Texas at Austin, Austin, TX, 78712, USA.
- Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, TX, 78712, USA.
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Abstract
Background: Some levothyroxine (LT4)-treated hypothyroid patients report a constellation of persistent and distressing cognitive symptoms that has been termed brain fog. This narrative review focuses on attempts to define and measure hypothyroid-associated brain fog, summarize possible etiologies and contributing factors, present treatment options, and propose avenues for future research. Methods: Published literature was reviewed to summarize available information on patient-reported symptoms associated with brain fog in hypothyroidism, as well as objective evidence of impairment based on neurocognitive testing and functional imaging studies. Given the limited information specific for hypothyroid-associated brain fog, relevant data from other medical conditions associated with brain fog were also reviewed and incorporated into recommendations for clinical care and future research areas. Results: Hypothyroid-associated brain fog has not been well defined or quantitated, and the underlying pathophysiology is unclear. Symptoms vary among patients but commonly include fatigue, depressed mood, and cognitive difficulties in the areas of memory and executive function. Symptoms often predate the diagnosis of hypothyroidism, and the magnitude of cognitive impairment can range from mild to severe. Regardless of severity, these symptoms are associated with impaired quality of life and cause dissatisfaction with treatment, so often lead to requests for alternate therapies. Disease-specific and psychological factors impact the experience of brain fog in complex ways, including potential limitations in LT4 monotherapy, self-knowledge of a disease state, and expectations for therapeutic effects. Conclusions: Brain fog is a variable symptom complex in people with hypothyroidism, causing significant distress and diminished quality of life. In the absence of proven therapies, individualized treatment plans are recommended, which incorporate thyroid-specific, general medical, and psychosocial approaches. In particular, cognitive rehabilitation is an underutilized technique that is beneficial in other medical conditions associated with brain fog and could improve symptoms in hypothyroid people. The limitations in our current knowledge and questions presented throughout this review highlight a major need for clinical research in this understudied area. Future research should include attention to standardization of survey instruments to quantitate brain fog in hypothyroid people, as well as rigorously designed intervention studies.
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Affiliation(s)
- Mary H. Samuels
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA
- Address correspondence to: Mary H. Samuels, MD, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, 3181 Sam Jackson Park Road, CR107, Portland, OR 97221, USA
| | - Lori J. Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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11
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Boberg E, Iacobaeus E, Greenfield MS, Wang Y, Msghina M, Le Blanc K. Reduced prefrontal cortex and sympathetic nervous system activity correlate with fatigue after aHSCT. Bone Marrow Transplant 2022; 57:360-369. [PMID: 34864824 PMCID: PMC8907068 DOI: 10.1038/s41409-021-01539-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
Long-term fatigue and cognitive dysfunction affects 35% of allogeneic haematopoietic stem cell transplantation (aHSCT) survivors, suggesting a dysfunctional prefrontal cortex. In this study, we assessed prefrontal cortex and sympathetic nervous system activity in aHSCT patients with fatigue (n = 12), non-fatigued patients (n = 12) and healthy controls (n = 27). Measurement of near-infrared spectroscopy and electrodermal activity was carried out at rest and during cognitive performance (Stroop, verbal fluency and emotion regulation tasks). Prefrontal cortex and sympathetic nervous system activity were also analyzed in response to dopamine and noradrenaline increase after a single dose of methylphenidate. Baseline cognitive performance was similar in the two patient groups. However, after methylphenidate, only non-fatigued patients improved in Stroop accuracy and had better verbal fluency task performance compared to the fatigued group. Task-related activation of prefrontal cortex in fatigued patients was lower compared to non-fatigued patients during all cognitive tests, both before and after methylphenidate administration. During the Stroop task, reaction time, prefrontal cortex activation, and sympathetic nervous system activity were all lower in fatigued patients compared to healthy controls, but similar in non-fatigued patients and healthy controls.Reduced prefrontal cortex activity and sympathetic arousal suggests novel treatment targets to improve fatigue after aHSCT.
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Affiliation(s)
- Erik Boberg
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. .,Department of Haematology, Karolinska University Hospital, Stockholm, Sweden.
| | - Ellen Iacobaeus
- grid.4714.60000 0004 1937 0626Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Yanlu Wang
- grid.24381.3c0000 0000 9241 5705Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Radiology, Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mussie Msghina
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Katarina Le Blanc
- grid.4714.60000 0004 1937 0626Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Cellular therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
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