Anthracycline-based breast cancer chemotherapy linked to neurotoxicity

By Shreeya Nanda, Senior medwireNews Reporter

Breast cancer patients treated with anthracycline-based chemotherapy regimens may be at greater risk of neurocognitive problems than those given nonanthracycline regimens, indicate findings.

Specifically, the 20 women who had received standard-dose doxorubicin-based treatment at least 6 months prior to analysis demonstrated significantly poorer verbal memory performance than the 19 treated with nonanthracycline-based chemotherapy and the 23 who did not receive chemotherapy. This was the case for both the total recall and delayed recall sections of the Hopkins Verbal Learning Test–Revised.

And resting-state functional magnetic resonance imaging showed that the anthracycline group demonstrated significantly reduced left precuneus connectivity with the left lateral parietal, left medial frontal, right hippocampal, bilateral middle cingulate and right superior frontal gyrus compared with either of the other groups.

Lower connectivity was not restricted to anthracycline-treated patients – those given nonanthracycline regimens demonstrated lower connectivity than the no-chemotherapy group, but only between the left precuneus and right middle cingulate.

Given that the precuneus has a role in various cognitive functions, including memory, Shelli Kesler (University of Texas MD Anderson Cancer Center, Houston, USA) and Douglas Blayney (Stanford University School of Medicine, California, USA) speculate that “disrupted connections between the precuneus and frontal-hippocampal regions would particularly affect memory function.”

They also found that both anthracycline- and nonanthracycline-treated participants reported greater cognitive dysfunction and psychological distress – as assessed by the Behavioral Rating Inventory of Executive Function and the Clinical Assessment of Depression– than those not given chemotherapy.

In an accompanying editorial, also published in JAMA Oncology, Andrew Saykin (Indiana University School of Medicine, Indianapolis, USA) and co-authors note that patients in the nonanthracycline group showed subjective symptom elevation despite the lack of performance deficits.

As such they think it would be useful to understand “the relationship between subjective symptoms and connectivity measurements” in order to clarify the mechanisms underlying post-treatment cognitive problems in patients with cancer.

Saykin et al conclude that this study “represents an important step forward while underscoring the need for larger studies”, which they say would not only enable further discrimination of the effects of different regimens, but also allow the evaluation of other patient-specific factors, such as genetic variability.

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