1860P - Objective and subjective neurocognitive functioning (NCF) in advanced cancer survivors treated with immune checkpoint blockade (ICB)

Background

Limited knowledge currently exists on NCF in advanced cancer survivors treated with ICB. Here, we present the baseline data of an ongoing prospective trial regarding objective and subjective NCF.

Methods

Patients (pts) followed-up at a single center, diagnosed with stage III/IV cancer of any type, who initiated ICB at least one year prior to and were in complete remission (CR) at time of inclusion, were invited to participate. Objective NCF was assessed using the test battery COGBAT®. Neurocognitive impairment (NCI) was defined by the International Cancer and Cognition Taskforce guidelines and deficits per subtest as 1.5 standard deviation below the normative mean. Subjective NCF, anxiety, depression and fatigue were assessed respectively through the Cognitive Failures Questionnaire, Hospital Anxiety and Depression Scale, and Fatigue Severity Scale.

Results

From July 2022 to April 2023, 58 pts were enrolled (48 melanoma, 6 non-small cell lung carcinoma, 2 colon cancer, 1 renal cell carcinoma, 1 bladder cancer), median age was 64 y [34-92]); 34 male; 55 pts (95%) had stage IV disease; 12 pts (21%) had a history of brain metastasis. Median time since CR was 3.0 y [0.1-14.1]; median time since last ICB administration was 3.6 y [0.0-11.4]. We found objective NCI in 34 pts (59%), with deficits predominantly in memory (33%) and attention (31%) and in a lesser amount in executive functioning (16%). Moderate to severe subjective cognitive complaints were found in 12 pts (21%). Objective NCF only correlated significantly with age (r = -.782, p < .001) but not with subjective NCF, fatigue, anxiety, depression or a history of brain metastasis. Subjective NCF correlated significantly with anxiety, depression and fatigue (respectively r = .694, r = .454, r = .447, all p-values < .001).

Conclusions

A majority of the advanced cancer survivors treated with ICB had objective NCI. A noteworthy lesser proportion had subjective cognitive complaints, indicating the need of neuropsychological assessment. Moderate to strong associations exist between subjective NCF and psychological distress, indicating the value of an integrative approach, including NCF remediation and psychosocial support when treating cognitive complaints.

Clinical trial identification

NCT05667857.

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Fonds Wetenschappelijk Onderzoek Vlaanderen.

Disclosure

S. Aspeslagh: Financial Interests, Institutional, Advisory Board: MSD, Sanofi, Roche, BMS, Pfizer, Ipsen, Galapagos. L. Decoster: Financial Interests, Institutional, Advisory Board: AstraZeneca, BMS, MSD; Financial Interests, Institutional, Invited Speaker: BMS, MSD, Roche, Servier, Sanofi; Financial Interests, Institutional, Research Grant, conduct of academic trial: Boehringer Ingelheim; Non-Financial Interests, Leadership Role, member of board: European Cancer Organisation; Non-Financial Interests, Leadership Role, Board member: International Society of Geriatric Oncology (SIOG). A. Rogiers: Financial Interests, Institutional, Advisory Role: BMS, MSD. B. Neyns: Financial Interests, Institutional, Advisory Board: Novartis, BMS, Pierre-Fabre, MSD (Merck Sharp & Dohme); Financial Interests, Institutional, Research Grant: Novartis, Pfizer; Non-Financial Interests, Institutional, Product Samples: Bayer. All other authors have declared no conflicts of interest.