A collaborative research effort from investigators at the University of Texas MD Anderson Cancer Center (TX, USA) and Stanford University School of Medicine (CA, USA) has suggested that anthracycline-based chemotherapy may have greater negative effects on particular cognitive domains and brain network connections than nonanthracycline-based regimens.
Cancer-related cognitive impairment, commonly termed ‘chemobrain’, often occurs in patients treated for breast cancer. However, it was previously unclear whether certain chemotherapy regimens caused greater cognitive dysfunction than others.
Recently published online in the journal JAMA Oncology, this collaborative study analyzed the effects of anthracycline and nonanthracycline chemotherapy regimens on cognitive status and functional brain connectivity in primary breast cancer survivors.
The study sample comprised 62 primary breast cancer survivors, who had ceased chemotherapy for an average of more than 2 years. Of the patients, 20 individuals had received anthracycline-based chemotherapy as part of their primary treatment, 19 individuals received nonanthracycline regimens and 23 individuals did not receive any chemotherapy. Cognitive tests were performed and imaging data were analyzed in order to assess cognitive status and functional brain connectivity of the study subjects.
The group of women who had received anthracycline-based chemotherapy had lower verbal memory, including immediate and delayed recall, when compared with the nonanthracycline chemotherapy and no chemotherapy groups. The results of the study also indicated that anthracycline regimens were associated with lower default mode brain network connectivity, which suggests a decreased efficiency of information processing.
Furthermore, patient-reported outcomes of cognitive dysfunction and psychological distress were increased in both chemotherapy groups, when compared with the group not treated with chemotherapy.
The authors acknowledge that the small sample size and retrospective, cross-sectional design are limitations of this research. However, they indicate that larger, prospective studies are needed that include pretreatment and posttreatment assessments so that patients’ individual cognitive and neurobiologic trajectories can be evaluated with respect to potential anthracycline-related neurotoxic effects.