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Duivon M, Lequesne J, Di Meglio A, Pradon C, Vaz-Luis I, Martin AL, Everhard S, Broutin S, Rigal O, Bousrih C, Lévy C, Lerebours F, Lange M, Joly F. Inflammation at diagnosis and cognitive impairment two years later in breast cancer patients from the Canto-Cog study. Breast Cancer Res 2024; 26:93. [PMID: 38840166 PMCID: PMC11151649 DOI: 10.1186/s13058-024-01850-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Inflammation could be related to cancer-related cognitive impairment (CRCI) and might be used as a predictive marker of long-term CRCI. We evaluated associations between inflammatory markers assessed at diagnosis of breast cancer and CRCI two years afterwards. METHODS Newly diagnosed stage I-III patients with breast cancer from the French CANTO-Cog (Cognitive sub-study of CANTO, NCT01993498) were included at diagnosis (baseline). Serum inflammatory markers (IL-2, IL-4, IL-6, IL-8, IL-10, TNFα, CRP) were assessed at baseline. Outcomes at year 2 post-baseline included overall cognitive impairment (≥ 2 impaired domains) and the following domains: episodic memory, working memory, attention, processing speed, and executive functions. Multivariable logistic regression models evaluated associations between markers and outcomes, controlling for age, education, and baseline cognitive impairment. RESULTS Among 200 patients, the mean age was 54 ± 11 years, with 127 (64%) receiving chemotherapy. Fifty-three (27%) patients had overall cognitive impairment at both timepoints. Overall cognitive impairment at year 2 was associated with high (> 3 mg/L) baseline CRP (OR = 2.84, 95%CI: 1.06-7.64, p = 0.037). In addition, associations were found between high CRP and processing speed impairment (OR = 2.47, 95%CI:1.05-5.87, p = 0.039), and between high IL-6 and episodic memory impairment (OR = 5.50, 95%CI:1.43-36.6, p = 0.010). CONCLUSIONS In this cohort, high levels of CRP and IL-6 assessed at diagnosis were associated with overall CRCI, processing speed and episodic memory impairments two years later. These findings suggest a potential inflammatory basis for long-term CRCI. CRP may represent an easily measurable marker in clinical settings and be potentially used to screen patients at greater risk of persistent CRCI.
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Affiliation(s)
- Mylène Duivon
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France
| | - Justine Lequesne
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France
- Clinical Research Department, UNICANCER, Centre François Baclesse, 3 Av. du Général Harris, 14000, Caen, France
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, 14000, Caen, France
| | - Antonio Di Meglio
- Cancer Survivorship Group, INSERM U981, Gustave Roussy, Villejuif, France
| | - Caroline Pradon
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Cancer Survivorship Group, INSERM U981, Gustave Roussy, Villejuif, France
- DIOPP, Gustave Roussy, Villejuif, France
| | | | | | - Sophie Broutin
- Biological Resource Center, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Olivier Rigal
- Care Support Department, Centre Henri Becquerel, 76000, Rouen, France
- Medical Oncology Department, Centre Henri Becquerel, 76000, Rouen, France
| | | | - Christelle Lévy
- Institut Normand du Sein, Centre François Baclesse, 14000, Caen, France
| | | | - Marie Lange
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France.
- Clinical Research Department, UNICANCER, Centre François Baclesse, 3 Av. du Général Harris, 14000, Caen, France.
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, 14000, Caen, France.
| | - Florence Joly
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France
- Clinical Research Department, UNICANCER, Centre François Baclesse, 3 Av. du Général Harris, 14000, Caen, France
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, 14000, Caen, France
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Conti L, Pizzoli SFM, Marzorati C, Grasso R, Petralia G, Pravettoni G. Cognitive alterations and brain functional changes following chemotherapy treatment in breast cancer patients: A systematic review on resting-state fMRI studies. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-16. [PMID: 38261545 DOI: 10.1080/23279095.2024.2303362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Cognitive dysfunctions and functional brain modifications are among the side effects reported by breast cancer patients that persist beyond the chemotherapy. This paper aims at synthesizing the evidence on cognitive and functional brain changes and their associations in breast cancer patients treated with chemotherapy. A systematic literature search was performed using PubMed, Ovid MEDLINE, Scopus, and Embase up to July 2022. Eligible studies evaluated adult women with breast cancer treated with systemic chemotherapy, that performed cognitive assessment and resting-state functional MRI. Methodological quality was assessed. Sixteen studies were included, with a total of 1054 female participants. All studies reported alterations mainly concerned the fronto-parieto-temporal system and specifically involved the disruption of the DMN. Consistent with these findings, BCPs showed changes in cognitive performance reporting dysfunctions in executive ability, memory, and attention. However, not all the studies found a significant association between functional brain alterations and cognitive dysfunction. Some limitations including lack of sample homogeneity and different methodological approaches were reported. This work highlighted the presence of cognitive dysfunctions and functional brain alteration in breast cancer patients treated with chemotherapy. This allows a greater awareness of the side effects, promoting better clinical management. However, further research is needed to investigate the cause-effect relationship between cognitive and functional alterations.
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Affiliation(s)
- Lorenzo Conti
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
| | | | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milan, Milano, Italy
| | - Giuseppe Petralia
- Department of Oncology and Haemato-Oncology, University of Milan, Milano, Italy
- Division of Radiology, IRCCS European Institute of Oncology, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milan, Milano, Italy
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Schroyen G, Sleurs C, Ottenbourgs T, Leenaerts N, Nevelsteen I, Melis M, Smeets A, Deprez S, Sunaert S. Changes in leukoencephalopathy and serum neurofilament after (neo)adjuvant chemotherapy for breast cancer. Transl Oncol 2023; 37:101769. [PMID: 37651891 PMCID: PMC10480307 DOI: 10.1016/j.tranon.2023.101769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Previous case studies have provided evidence for chemotherapy-induced leukoencephalopathy in patients with breast cancer. However, prospective research is lacking. Hence, we investigated leukoencephalopathy before and after chemotherapy and its association with a serum neuroaxonal damage marker. METHODS This prospective cohort study included 40 patients receiving chemotherapy for breast cancer, and two age- and education-matched control groups, recruited between 2018 and 2021 (31-64 years of age). The latter control groups consisted of 39 chemotherapy-naïve patients and 40 healthy women. Fluid-attenuated inversion-recovery magnetic resonance imaging was used for lesion volumetry (total, juxtacortical, periventricular, infratentorial, and deep white matter) and blood serum to measure neurofilament light chain (NfL) levels. Acquisition took place pre-chemotherapy and three months and one-year post-chemotherapy, or at corresponding intervals. Within/between group differences were compared using robust mixed-effects modeling, and associations between total lesion volume and serum-NfL with linear regression. RESULTS Stronger increases in deep white matter lesion volumes were observed shortly post-chemotherapy, compared with healthy women (ßstandardized=0.09, pFDR<0.001). Increases in total lesion volume could mainly be attributed to enlargement of existing lesions (mean±SD, 0.12±0.16 mL), rather than development of new lesions (0.02±0.02 mL). A stronger increase in serum-NfL concentration was observed shortly post-chemotherapy compared with both control groups (ß>0.70, p<0.004), neither of which showed any changes over time, whereas a decrease was observed compared with healthy women one-year post-chemotherapy (ß=-0.54, p = 0.002). Serum-NfL concentrations were associated with lesion volume one-year post-chemotherapy (or at matched timepoint; ß=0.36, p = 0.010), whereas baseline or short-term post-therapy levels or changes were not. CONCLUSION These results underscore the possibility of chemotherapy-induced leukoencephalopathy months post-treatment, as well as the added value of serum-NfL as a prognostic marker for peripheral/central neurotoxicity. TRANSLATIONAL RELEVANCE Previous case studies have provided evidence of chemotherapy-induced leukoencephalopathy in patients with breast cancer. However, prospective studies to estimate longitudinal changes are currently missing. In this study, we used longitudinal fluid-attenuated inversion-recovery magnetic resonance imaging to assess white matter lesion volumes in patients treated for non-metastatic breast cancer and healthy women. Our findings demonstrate that chemotherapy-treated patients exhibit stronger increases in lesion volumes compared with healthy women, specifically in deep white matter, at three months post-chemotherapy. Increases could mainly be attributed to enlargement of existing lesions, rather than development of new lesions. Last, serum concentrations of neurofilament light chain, a neuroaxonal damage marker, increased shortly after chemotherapy and long-term post-chemotherapy levels were associated with lesion volumes. These findings highlight the potential of this non-invasive serum marker as a prognostic marker for peripheral and/or central neurotoxicity. Implementation in clinical practice could aid in therapeutic decisions, assessing disease activity, or monitoring treatment response.
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Affiliation(s)
- Gwen Schroyen
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Charlotte Sleurs
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; Tilburg University, Department of Cognitive Neuropsychology, Tilburg, the Netherlands; KU Leuven, Department of Oncology, Leuven, Belgium
| | - Tine Ottenbourgs
- KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Nicolas Leenaerts
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; KU Leuven, Department of Neurosciences, Mind-Body Research, Leuven, Belgium; KU Leuven, University Psychiatric Center, Leuven, Belgium; University Hospitals Leuven, Department of Psychiatry, Leuven, Belgium
| | - Ines Nevelsteen
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Oncology, Leuven, Belgium; University Hospitals Leuven, Department of Oncology, Surgical Oncology, Leuven, Belgium
| | - Michelle Melis
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Ann Smeets
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Oncology, Leuven, Belgium; University Hospitals Leuven, Department of Oncology, Surgical Oncology, Leuven, Belgium
| | - Sabine Deprez
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium.
| | - Stefan Sunaert
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium; University Hospitals Leuven, Department of Radiology, Leuven, Belgium
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Kesler SR, Henneghan AM, Prinsloo S, Palesh O, Wintermark M. Neuroimaging based biotypes for precision diagnosis and prognosis in cancer-related cognitive impairment. Front Med (Lausanne) 2023; 10:1199605. [PMID: 37720513 PMCID: PMC10499624 DOI: 10.3389/fmed.2023.1199605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Cancer related cognitive impairment (CRCI) is commonly associated with cancer and its treatments, yet the present binary diagnostic approach fails to capture the full spectrum of this syndrome. Cognitive function is highly complex and exists on a continuum that is poorly characterized by dichotomous categories. Advanced statistical methodologies applied to symptom assessments have demonstrated that there are multiple subclasses of CRCI. However, studies suggest that relying on symptom assessments alone may fail to account for significant differences in the neural mechanisms that underlie a specific cognitive phenotype. Treatment plans that address the specific physiologic mechanisms involved in an individual patient's condition is the heart of precision medicine. In this narrative review, we discuss how biotyping, a precision medicine framework being utilized in other mental disorders, could be applied to CRCI. Specifically, we discuss how neuroimaging can be used to determine biotypes of CRCI, which allow for increased precision in prediction and diagnosis of CRCI via biologic mechanistic data. Biotypes may also provide more precise clinical endpoints for intervention trials. Biotyping could be made more feasible with proxy imaging technologies or liquid biomarkers. Large cross-sectional phenotyping studies are needed in addition to evaluation of longitudinal trajectories, and data sharing/pooling is highly feasible with currently available digital infrastructures.
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Affiliation(s)
- Shelli R. Kesler
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Diagnostic Medicine, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Ashley M. Henneghan
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Oxana Palesh
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Cancer, Houston, TX, United States
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5
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Mandelblatt JS, Small BJ, Zhou X, Nakamura ZM, Cohen HJ, Ahles TA, Ahn J, Bethea TN, Extermann M, Graham D, Isaacs C, Jacobsen PB, Jim HSL, McDonald BC, Patel SK, Rentscher KE, Root JC, Saykin AJ, Tometich DB, Van Dyk K, Zhai W, Breen EC, Carroll JE. Plasma levels of interleukin-6 mediate neurocognitive performance in older breast cancer survivors: The Thinking and Living With Cancer study. Cancer 2023; 129:2409-2421. [PMID: 37096888 PMCID: PMC10750797 DOI: 10.1002/cncr.34784] [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: 10/15/2022] [Revised: 02/08/2023] [Accepted: 03/03/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Immune activation/inflammation markers (immune markers) were tested to explain differences in neurocognition among older breast cancer survivors versus noncancer controls. METHODS Women >60 years old with primary breast cancer (stages 0-III) (n = 400) were assessed before systemic therapy with frequency-matched controls (n = 329) and followed annually to 60 months; blood was collected during annual assessments from 2016 to 2020. Neurocognition was measured by tests of attention, processing speed, and executive function (APE). Plasma levels of interleukin-6 (IL-6), IL-8, IL-10, tumor necrosis factor α (TNF-α), and interferon γ were determined using multiplex testing. Mixed linear models were used to compare results of immune marker levels by survivor/control group by time and by controlling for age, racial/ethnic group, cognitive reserve, and study site. Covariate-adjusted multilevel mediation analyses tested whether survivor/control group effects on cognition were explained by immune markers; secondary analyses examined the impact of additional covariates (e.g., comorbidity and obesity) on mediation effects. RESULTS Participants were aged 60-90 years (mean, 67.7 years). Most survivors had stage I (60.9%) estrogen receptor-positive tumors (87.6%). Survivors had significantly higher IL-6 levels than controls before systemic therapy and at 12, 24, and 60 months (p ≤ .001-.014) but there were no differences for other markers. Survivors had lower adjusted APE scores than controls (p < .05). Levels of IL-6, IL-10, and TNF-α were related to APE, with IL-6 explaining part of the relationship between survivor/control group and APE (p = .01). The magnitude of this mediation effect decreased but remained significant (p = .047) after the consideration of additional covariates. CONCLUSIONS Older breast cancer survivors had worse long-term neurocognitive performance than controls, and this relationship was explained in part by elevated IL-6.
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Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Cancer Prevention and Control Program, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Department of Oncology and Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Harvey J Cohen
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Department of Oncology and Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Traci N Bethea
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Cancer Prevention and Control Program, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Martine Extermann
- Department of Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida, USA
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Department of Oncology, Department of Medicine, Georgetown University, Washington, DC, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Heather S L Jim
- Cancer Prevention and Control Program, H. Lee Moffitt Comprehensive Cancer Center, Tampa, Florida, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sunita K Patel
- City of Hope National Medical Center, Los Angeles, California, USA
| | - Kelly E Rentscher
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Danielle B Tometich
- Cancer Prevention and Control Program, H. Lee Moffitt Comprehensive Cancer Center, Tampa, Florida, USA
| | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Department of Oncology and Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Elizabeth C Breen
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California, USA
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California, USA
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Melis M, Schroyen G, Blommaert J, Leenaerts N, Smeets A, Van Der Gucht K, Sunaert S, Deprez S. The Impact of Mindfulness on Functional Brain Connectivity and Peripheral Inflammation in Breast Cancer Survivors with Cognitive Complaints. Cancers (Basel) 2023; 15:3632. [PMID: 37509292 PMCID: PMC10377401 DOI: 10.3390/cancers15143632] [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: 05/05/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Cancer-related cognitive impairment (CRCI) has been linked to functional brain changes and inflammatory processes. Hence, interventions targeting these underlying mechanisms are needed. In this study, we investigated the effects of a mindfulness-based intervention on brain function and inflammatory profiles in breast cancer survivors with CRCI. METHODS Female breast cancer survivors reporting cognitive complaints (n = 117) were randomly assigned to a mindfulness-based intervention (n = 43), physical training (n = 36), or waitlist control condition (n = 38). Region-of-interest (ROI) and graph theory analyses of resting state functional MRI data were performed to study longitudinal group differences in functional connectivity and organization in the default mode, dorsal attention, salience, and frontoparietal network. Additionally, bead-based immunoassays were used to investigate the differences in inflammatory profiles on serum samples. Measures were collected before, immediately after and three months post-intervention. RESULTS No ROI-to-ROI functional connectivity changes were identified. Compared to no intervention, graph analysis showed a larger decrease in clustering coefficient after mindfulness and physical training. Additionally, a larger increase in global efficiency after physical training was identified. Furthermore, the physical training group showed a larger decrease in an inflammatory profile compared to no intervention (IL-12p70, IFN-γ, IL-1β, and IL-8). CONCLUSION Both mindfulness and physical training induced changes in the functional organization of networks related to attention, emotion processing, and executive functioning. While both interventions reduced functional segregation, only physical training increased functional integration of the neural network. In conclusion, physical training had the most pronounced effects on functional network organization and biomarkers of inflammation, two mechanisms that might be involved in CRCI.
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Affiliation(s)
- Michelle Melis
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
| | - Gwen Schroyen
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
| | - Jeroen Blommaert
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Oncology, Gynecological Oncology, Catholic University Leuven, 3000 Leuven, Belgium
| | - Nicolas Leenaerts
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Neurosciences, Mind-Body Research, Catholic University Leuven, 3000 Leuven, Belgium
| | - Ann Smeets
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Oncology, Surgical Oncology, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Surgical Oncology, Multidisciplinary Breast Center, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Katleen Van Der Gucht
- Tilburg School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands
- Leuven Mindfulness Centre, Faculty of Psychology and Educational Sciences, Catholic University Leuven, 3000 Leuven, Belgium
- Neuromodulation Laboratory, Biomedical Sciences Group, Department of Rehabilitation Sciences, Catholic University Leuven, 3000 Leuven, Belgium
| | - Stefan Sunaert
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Sabine Deprez
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
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7
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Carroll JE, Nakamura ZM, Small BJ, Zhou X, Cohen HJ, Ahles TA, Ahn J, Bethea TN, Extermann M, Graham D, Isaacs C, Jim HS, Jacobsen PB, McDonald BC, Patel SK, Rentscher K, Root J, Saykin AJ, Tometich DB, Van Dyk K, Zhai W, Breen EC, Mandelblatt JS. Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study. J Clin Oncol 2023; 41:295-306. [PMID: 36179271 PMCID: PMC9839283 DOI: 10.1200/jco.22.00406] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/24/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To examine longitudinal relationships between levels of C-reactive protein (CRP) and cognition in older breast cancer survivors and noncancer controls. METHODS English-speaking women age ≥ 60 years, newly diagnosed with primary breast cancer (stage 0-III), and frequency-matched controls were enrolled from September 2010 to March 2020; women with dementia, neurologic disorders, and other cancers were excluded. Assessments occurred presystemic therapy/enrollment and at annual visits up to 60 months. Cognition was measured using the Functional Assessment of Cancer Therapy-Cognitive Function and neuropsychological testing. Mixed linear effect models tested for survivor-control differences in natural log (ln)-transformed CRP at each visit. Random effect-lagged fluctuation models tested directional effects of ln-CRP on subsequent cognition. All models controlled for age, race, study site, cognitive reserve, obesity, and comorbidities; secondary analyses evaluated if depression or anxiety affected results. RESULTS There were 400 survivors and 329 controls with CRP specimens and follow-up data (average age of 67.7 years; range, 60-90 years). The majority of survivors had stage I (60.9%), estrogen receptor-positive (87.6%) tumors. Survivors had significantly higher adjusted mean ln-CRP than controls at baseline and 12-, 24-, and 60-month visits (all P < .05). Higher adjusted ln-CRP predicted lower participant-reported cognition on subsequent visits among survivors, but not controls (P interaction = .008); effects were unchanged by depression or anxiety. Overall, survivors had adjusted Functional Assessment of Cancer Therapy-Cognitive Function scores that were 9.5 and 14.2 points lower than controls at CRP levels of 3.0 and 10.0 mg/L. Survivors had poorer neuropsychological test performance (v controls), with significant interactions with CRP only for the Trails B test. CONCLUSION Longitudinal relationships between CRP and cognition in older breast cancer survivors suggest that chronic inflammation may play a role in development of cognitive problems. CRP testing could be clinically useful in survivorship care.
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Affiliation(s)
- Judith E. Carroll
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Zev M. Nakamura
- Department of Psychiatry, University of North Carolina–Chapel Hill, Chapel Hill, NC
| | - Brent J. Small
- School of Aging Studies, University of South Florida, Tampa, FL
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Harvey J. Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
| | - Tim A. Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Traci N. Bethea
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | | | - Paul B. Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Brenna C. McDonald
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN
| | | | - Kelly Rentscher
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - James Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J. Saykin
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN
| | | | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Elizabeth C. Breen
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
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Taylor MR, Steineck A, Lahijani S, Hall AG, Jim HSL, Phelan R, Knight JM. Biobehavioral Implications of Chimeric Antigen Receptor T-cell Therapy: Current State and Future Directions. Transplant Cell Ther 2023; 29:19-26. [PMID: 36208728 DOI: 10.1016/j.jtct.2022.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has demonstrated remarkable clinical responses in hematologic malignancies. Recent advances in CAR T-cell therapy have expanded its application into other populations including older patients and those with central nervous system and solid tumors. Although its clinical efficacy has been excellent for some malignancies, CAR T-cell therapy is associated with severe and even life-threatening immune-mediated toxicities, including cytokine release syndrome and neurotoxicity. There is a strong body of scientific evidence highlighting the connection between immune activation and neurocognitive and psychological phenomena. To date, there has been limited investigation into this relationship in the context of immunotherapy. In this review, we present a biobehavioral framework to inform current and future cellular therapy research and contribute to improving the multidimensional outcomes of patients receiving CAR T-cell therapy.
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Affiliation(s)
- Mallory R Taylor
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle, Washington; Palliative Care and Resilience Program, Seattle Children's Research Institute, Seattle, Washington
| | - Angela Steineck
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin
| | - Sheila Lahijani
- Division of Medical Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Anurekha G Hall
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Rachel Phelan
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin
| | - Jennifer M Knight
- Departments of Psychiatry, Medicine, and Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Schroyen G, Schramm G, Van Weehaeghe D, Leenaerts N, Vande Casteele T, Blommaert J, Koole M, Smeets A, Van Laere K, Sunaert S, Deprez S. Cerebral glucose changes after chemotherapy and their relation to long-term cognitive complaints and fatigue. Front Oncol 2022; 12:1021615. [PMID: 36313711 PMCID: PMC9612406 DOI: 10.3389/fonc.2022.1021615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the short-term cerebral metabolic effects of intravenous chemotherapy and their association with long-term fatigue/cognitive complaints. Experimental design Using [18F]-FDG-PET/CT whole-body scans, we retrospectively quantified relative cerebral glucose metabolism before and after neoadjuvant chemotherapy in a cohort of patients treated for non-metastatic breast cancer (2009-2019). Self-report of cognitive complaints and fatigue were prospectively assessed 7 ± 3 years after therapy. Metabolic changes were estimated with i) robust mixed-effects modelling in regions-of-interest (frontal, parietal, temporal, occipital, and insular cortex) and ii) general-linear modelling of whole-brain voxel-wise outcomes. iii) The association between metabolic changes and self-reported outcomes was evaluated using linear regression-analysis. Results Of the 667 screened patients, 263 underwent PET/CT before and after chemotherapy and 183 (48 ± 9 years) met the inclusion criteria. After chemotherapy, decreased frontal and increased parietal and insular metabolism were observed (|ß|>0.273, pFDR<0.008). Separately, additional increased occipital metabolism after epiribucin+ cyclophosphamide (EC) and temporal metabolism after EC+ fluorouracil chemotherapy were observed (ß>0.244, pFDR≤0.048). Voxel-based analysis (pcluster-FWE<0.001) showed decreased metabolism in the paracingulate gyrus (-3.2 ± 3.9%) and putamen (3.1 ± 4.1%) and increased metabolism in the lateral cortex (L=2.9 ± 3.1%) and pericentral gyri (3.0 ± 4.4%). Except for the central sulcus, the same regions showed changes in EC, but not in FEC patients. Of the 97 self-reported responders, 23% and 27% experienced extreme fatigue and long-term cognitive complaints, respectively, which were not associated with metabolic changes. Conclusion Both hyper- and hypometabolism were observed after chemotherapy for breast cancer. Combined with earlier findings, this study could support inflammatory mechanisms resulting in relative hypermetabolism, mainly in the parietal/occipital cortices. As early metabolic changes did not precede long-term complaints, further research is necessary to identify vulnerable patients.
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Affiliation(s)
- Gwen Schroyen
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- *Correspondence: Gwen Schroyen,
| | - Georg Schramm
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Donatienne Van Weehaeghe
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
- Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Nicolas Leenaerts
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Mind-Body Research, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
- Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Vande Casteele
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
- Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Neuropsychiatry, KU Leuven, Leuven, Belgium
| | - Jeroen Blommaert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Oncology, Gynaecological Oncology, KU Leuven, Leuven, Belgium
| | - Michel Koole
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Ann Smeets
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Oncology, Surgical Oncology, KU Leuven, Leuven, Belgium
- Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Van Laere
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
- Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabine Deprez
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
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Al-Kaylani HM, Loeffler BT, Mott SL, Curry M, Phadke S, van der Plas E. Characterizing Early Changes in Quality of Life in Young Women With Breast Cancer. Front Psychol 2022; 13:871194. [PMID: 35645920 PMCID: PMC9132041 DOI: 10.3389/fpsyg.2022.871194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Younger age at diagnosis is a risk factor for poor health-related quality of life (HRQOL) in long-term breast cancer survivors. However, few studies have specifically addressed HRQOL in young adults with breast cancer (i.e., diagnosed prior to age 40), nor have early changes in HRQOL been fully characterized. Methods Eligible female patients with breast cancer were identified through our local cancer center. To establish HRQOL, patients completed the Functional Assessment of Cancer Therapy-Breast (FACT-B) around diagnosis and 12 months later. Sociodemographic factors, genetic susceptibility to cancer, tumor- and treatment-related factors, and comorbidities (e.g., depression/anxiety) were abstracted from medical records and the local oncology registry. Mixed-effects models were used to identify changes in FACT-B scores during the first year of treatment and to determine whether any demographic/treatment-related factors modulated changes in scores. Results Health-related quality of life in young patients with breast cancer was within normal limits at baseline, with a FACT-B overall well-being score of 108.5 (95% confidence limits [CI] = 103.7, 113.3). Participants reported slight improvements over a 12-month period: FACT-B overall well-being scores increased 6.6 points (95% CI = 2.1, 11.1, p < 0.01), functional well-being improved 3.0 points (95% CI = 2.0, 4.1, p < 0.01), emotional well-being improved 1.9 points (95% CI = 0.9, 2.8, p < 0.01), and physical well-being improved 1.5 points (95% CI = 0.2, 2.8, p = 0.03), on average. Participants with anxiety/depression at baseline reported greater improvements in FACT-B overall well-being (change: 12.9, 95% CI = 6.4, 9.5) and functional well-being (change: 5.2, 95% CI = 3.5, 6.9) than participants who did not have anxiety/depression at baseline (change in FACT-B overall well-being: 4.9, 95% CI = 0.2, 9.7; change in functional well-being: 2.3, 95% CI = 1.1, 3.4). Marital status, reconstructive surgery, and baseline clinical staging were also significantly associated with changes in aspects of HRQOL, although their impact on change was relatively minimal. Conclusion Young women with breast cancer do not report HRQOL concerns during the first year of treatment. Improvements in HRQOL during the first year of treatment may be attributable to a sense of relief that the cancer is being treated, which, in the short run, may outweigh the negative late effects of treatment.
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Affiliation(s)
- Hend M Al-Kaylani
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA, United States
| | - Bradley T Loeffler
- Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, IA, United States
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, IA, United States
| | - Melissa Curry
- Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, IA, United States
| | - Sneha Phadke
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA, United States
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Schroyen G, Sleurs C, Bartsoen E, Smeets D, van Weehaeghe D, Van Laere K, Smeets A, Deprez S, Sunaert S. Neuroinflammation as potential precursor of leukoencephalopathy in early-stage breast cancer patients: A cross-sectional PET-MRI study. Breast 2022; 62:61-68. [PMID: 35131644 PMCID: PMC8829129 DOI: 10.1016/j.breast.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Although chemotherapy-induced leukoencephalopathy has been described in case and cohort studies, literature remains inconclusive about its prevalence and mechanisms. Therefore, we investigated the presence of leukoencephalopathy after multiagent chemotherapy in women treated for breast cancer and potential underlying neuroinflammatory processes. Methods In this exploratory study, 15 chemotherapy-treated and 15 age-matched chemotherapy-naïve patients with early-stage breast cancer, as well as 15 healthy controls underwent simultaneous PET-MR neuroimaging, including T1-weighted MPRAGE, T2-weighted FLAIR and dynamic PET with the 18-kDA translocator protein (TSPO) radioligand [18F]DPA-714. Total and regional (juxtacortical, periventricular, deep white matter and infratentorial) lesion burden were compared between the groups with one-way ANOVA. With paired t-tests, [18F]DPA-714 volume of distribution [VT, including partial volume correction (PVC)] in lesioned and normal appearing white matter (NAWM) were compared within subjects, to investigate inflammation. Finally, two general linear models were used to examine the predictive values of neurofilament light-chain (NfL) serum levels on (1) total lesion burden or (2) PVC [18F]DPA-714 VT of lesions showing elevated inflammation. Results No significant differences were found in total or localized lesion burden. However, significantly higher (20–45%) TSPO uptake was observed in juxtacortical lesions (p ≤ 0.008, t ≥ 3.90) compared to NAWM in both cancer groups, but only persisted for chemotherapy-treated patients after PVC (p = 0.005, t = 4.30). NfL serum levels were not associated with total lesion volume or tracer uptake in juxtacortical lesions. Conclusion This multimodal neuroimaging study suggests that neuroinflammatory processes could be involved in the development of juxtacortical, but not periventricular or deep white matter, leukoencephalopathy shortly after chemotherapy for early-stage breast cancer. No increased white matter lesion load in breast cancer patients. No differences in TSPO uptake in periventricular or deep white matter lesions. Higher TSPO uptake in juxtacortical lesions in chemotherapy-treated breast cancer patients. TSPO uptake in inflammatory lesions and NfL levels not significantly associated, despite a trend.
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