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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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Ma Y, Liu N, Wang Y, Zhang A, Zhu Z, Zhang Z, Li Y, Jian G, Fu G, Dong M, Zheng G, Zhu P, Zhong G, Bai S, Chen S, Wei X, Tan J, Wang X. Cognitive adverse events in patients with lung cancer treated with checkpoint inhibitor monotherapy: a propensity score-matched analysis. EClinicalMedicine 2023; 59:101987. [PMID: 37152366 PMCID: PMC10154980 DOI: 10.1016/j.eclinm.2023.101987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/09/2023] Open
Abstract
Background Cancer-related cognitive decline is a serious problem in long-term survival but no pivotal study has investigated whether checkpoint inhibitors (ICI) may be associated with cognitive adverse events. Methods This propensity score-matched analysis recruited non-small cell lung cancer (NSCLC) patients prescribed with or without ICI monotherapy from three Chinese tertiary hospitals. Patients were excluded from study who developed brain metastasis or had disorders severely affecting cognitive abilities. Primary outcomes were changes in neuropsychological battery test (NBT) at baseline, 6- and 12-month sessions, and any NBT score changes that exceeded 3∗SD of baseline scores would be marked as objective cognitive adverse events (CoAE). Secondary endpoint was the 20-item Perceived Cognitive Impairment (PCI) sub-scale score change in Functional Assessment of Cancer Therapy-Cognitive Function questionnaire, administered at baseline, 3-, 6-, 9-, 12-, and 15-month follow-up session. Per-protocol ICI and control arms were matched with propensity scores that incorporated baseline variables to compare both NBT and PCI assessment results. Patients participating in PCI assessments were analysed in intention-to-treat analysis. Kaplan-Meier survival curves with log-rank tests were adopted to analyse incidence of perceived cognitive decline events (PCDE). Findings Between March 12, 2020, and March 28, 2021, 908 participants were enrolled. Compared to control, 3 of 4 subtest of NBT scores in ICI arm showed significant cognitive decline in 6- and 12-month sessions, in which Trail Making Test score change (13.56 ± 11.73) reached threshold of cognitive deficit diagnosis in the 12-month session. In 1:1 matched 292 pairs from 908 patients, PCI score changes in ICI arms were -4.26 ± 8.54 (3rd month), -4.72 ± 11.83 (6th month), -6.16 ± 15.41 (9th month), -6.07 ± 15.71 (12th month), and -7.96 ± 13.97 (15th month). The scores were significantly lower than control arm in 3-, 6-, and 12-session follow-up. The result was validated after adjusting quality of life scores and in intention-to-treat analysis. Mean PCI change exceeded 1/2 SD of baseline PCI score (5.81) in 9-, 12-, and 15-month sessions in ICI arm, but not in control arm. PCDE incidence/prevalence was significantly higher in ICI arm (incidence 26.4% vs. 5.1%, and prevalence 16.2% vs. 1.7%). Immune-related adverse events related to incidence of PCDE after adjusting for baseline variables. Interpretation ICI monotherapy seemed to relate to higher cognitive decline represented by score changes and incidence/prevalence rates. The decline deteriorated as treatment progressed, and immune-related adverse events seemed to be associated with higher cognitive adverse events incidence in the ICI treatment. Funding The Fellowship of China Postdoctoral Science Foundation and National Natural Science Foundation of China Youth Science Fund Project.
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Affiliation(s)
- Yifei Ma
- Department of Orthopedics and Spine Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Department of Bone and Soft Tissue Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Nianqi Liu
- Faculty of Psychology, Institute of Educational Science, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yanqi Wang
- Department of Bone and Soft Tissue Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- School of Public Health, Shantou University, Shantou, Guangdong Province, China
| | - Ao Zhang
- Department of Clinical Laboratory, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
- Corresponding author. Department of Clinical Laboratory, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Zirui Zhu
- Department of Thoracic Surgery, Hainan Hospital of People's Liberation Army General Hospital, Sanya, Hainan Province, China
| | - Zhiying Zhang
- Department of Bone and Soft Tissue Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- School of Public Health, Shantou University, Shantou, Guangdong Province, China
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Yiming Li
- Department of Neurosurgery, Beijing Tiantan Hospital Capital Medical University, Beijing, China
| | - Guangmin Jian
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Key Clinical Laboratory of Henan Province, Zhengzhou, Henan Province, China
| | - Guangzhen Fu
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Key Clinical Laboratory of Henan Province, Zhengzhou, Henan Province, China
| | - Mingming Dong
- Department of Bone and Soft Tissue Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Guoxing Zheng
- Department of Orthopedics and Spine Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Pengfei Zhu
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Key Clinical Laboratory of Henan Province, Zhengzhou, Henan Province, China
| | - Guanqing Zhong
- Department of Clinical Laboratory, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Shenrui Bai
- Department of Hematological Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Shuqin Chen
- Department of Pathology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Xiaolong Wei
- Department of Pathology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Jifan Tan
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xinjia Wang
- Department of Orthopedics and Spine Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Department of Bone and Soft Tissue Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Corresponding author. Department of Orthopedics and Spine Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.
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Oppegaard KR, Armstrong TS, Anguera JA, Kober KM, Debr LK, Laister RC, Saligan LN, Ayala AP, Kuruvilla J, Alm MW, Byker WH, Miaskowski C, Mayo SJ. Blood-Based Biomarkers of Cancer-Related Cognitive Impairment in Non-Central Nervous System Cancer: A Scoping Review. Crit Rev Oncol Hematol 2022; 180:103822. [PMID: 36152911 DOI: 10.1016/j.critrevonc.2022.103822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
This scoping review was designed to synthesize the extant literature on associations between subjective and/or objective measures of cancer-related cognitive impairment (CRCI) and blood-based biomarkers in adults with non-central nervous system cancers. The literature search was done for studies published from the start of each database searched (i.e., MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, grey literature) through to October 20, 2021. A total of 95 studies are included in this review. Of note, a wide variety of biomarkers were evaluated. Most studies evaluated patients with breast cancer. A variety of cognitive assessment measures were used. The most consistent significant findings were with various subjective and objective measures of CRCI and levels of interleukin-6 and tumor necrosis factor. Overall, biomarker research is in an exploratory phase. However, this review synthesizes findings and proposes directions for future research.
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Affiliation(s)
- Kate R Oppegaard
- University of California San Francisco, School of Nursing, Department of Physiological Nursing, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, USA
| | - Joaquin A Anguera
- University of California San Francisco, Department of Neurology and Psychiatry, USA
| | - Kord M Kober
- University of California San Francisco, School of Nursing, Department of Physiological Nursing, USA
| | - Lynch Kelly Debr
- University of Florida, College of Nursing, USA; University of Florida Health Cancer Center, USA
| | - Rob C Laister
- Princess Margaret Health Center, University Health Network, Canada
| | - Leorey N Saligan
- Symptoms Biology Unit, Division of Intramural Research, National Institutes of Health, USA
| | | | - John Kuruvilla
- Princess Margaret Health Center, University Health Network, Canada
| | - Mark W Alm
- Toronto General Hospital, University Health Network, Canada
| | | | - Christine Miaskowski
- University of California San Francisco, School of Medicine, Department of Anesthesia and Perioperative Care, USA
| | - Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada.
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Kesler SR, Tang T, Henneghan AM, Wright M, Gaber MW, Palesh O. Cross-Sectional Characterization of Local Brain Network Connectivity Pre and Post Breast Cancer Treatment and Distinct Association With Subjective Cognitive and Psychological Function. Front Neurol 2021; 12:746493. [PMID: 34777216 PMCID: PMC8586413 DOI: 10.3389/fneur.2021.746493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We aimed to characterize local brain network connectivity in long-term breast cancer survivors compared to newly diagnosed patients. Methods: Functional magnetic resonance imaging (fMRI) and subjective cognitive and psychological function data were obtained from a group of 76 newly diagnosed, pre-treatment female patients with breast cancer (mean age 57 ± 7 years) and a separate group of 80, post-treatment, female breast cancer survivors (mean age 58 ± 8; mean time since treatment 44 ± 43 months). The network-based statistic (NBS) was used to compare connectivity of local brain edges between groups. Hubs were defined as nodes with connectivity indices one standard deviation or more above network mean and were further classified as provincial (higher intra-subnetwork connectivity) or connector (higher inter-subnetwork connectivity) using the participation coefficient. We determined the hub status of nodes encompassing significantly different edges and correlated the centralities of edges with behavioral measures. Results: The post-treatment group demonstrated significantly lower subjective cognitive function (W = 3,856, p = 0.004) but there were no group differences in psychological distress (W = 2,866, p = 0.627). NBS indicated significantly altered connectivity (p < 0.042, corrected) in the post-treatment group compared to the pre-treatment group largely in temporal, frontal-temporal and temporal-parietal areas. The majority of the regions projecting these connections (78%) met criteria for hub status and significantly less of these hubs were connectors in the post-treatment group (z = 1.85, p = 0.031). Subjective cognitive function and psychological distress were correlated with largely non-overlapping edges in the post-treatment group (p < 0.05). Conclusion: Widespread functional network alterations are evident in long-term survivors of breast cancer compared to newly diagnosed patients. We also demonstrated that there are both overlapping and unique brain network signatures for subjective cognitive function vs. psychological distress.
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Affiliation(s)
- Shelli R. Kesler
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Tien Tang
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | | | - Michelle Wright
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - M. Waleed Gaber
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
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