Cognitive Decline In Early Breast Cancer Patients Detailed

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: Cancer-related cognitive impairment (CRCI) has been quantified in early breast cancer patients undergoing adjuvant endocrine therapy alone or alongside chemotherapy using data from the TAILORx trial, showing a short-term cognitive decline with both regimens. 

“Given the significant proportion of women with breast cancer who may benefit from chemotherapy, it is reassuring for patients and clinicians that the trajectory of cognitive impairment among women randomly assigned to [chemoendocrine therapy] converges with those receiving [endocrine therapy]”, say Lynne Wagner, from Wake Forest Baptist Comprehensive Cancer Center in Winston-Salem, North Carolina, USA, and co-workers. 

“However, increased impairment from pre- to posttreatment initiation observed in both groups underscores the need for clinical management of CRCI well beyond initiation of therapy, as well as the need for additional research to elucidate mechanisms and identify effective interventions”, they write in the Journal of Clinical Oncology. 

Patient-reported outcomes were collated from 552 evaluable participants, all of whom had hormone receptor-positive, HER2-negative, node-negative breast cancer and a mid-range 21-gene recurrence score. 

This revealed a significant increase in perceived cognitive impairment (PCI) at 3, 6, 12, 24 and 36 months of follow-up compared with baseline, as measured on a 20-item score within the Functional Assessment of Cancer Therapy–Cognitive Function survey, in both the chemoendocrine therapy and endocrine therapy alone groups. 

Patients who were randomly assigned to receive chemoendocrine therapy had a significantly greater change in PCI score than their counterparts given endocrine therapy alone at both the 3-month prespecified primary endpoint and at 6 months. 

The magnitude of change in PCI scores no longer significantly differed between the treatment arms at 12, 24 and 36 months of follow-up, although the authors emphasize that this outcome “was not due to improvement postchemotherapy in the [chemoendocrine therapy] group but rather due to declining scores among women receiving [endocrine therapy alone].”

The team found no significant difference in the trajectories of PCI scores by patient age nor evidence for an interaction between type of treatment received and menopausal status on cognition.

“Both [chemoendocrine therapy] and [endocrine therapy] were associated with lingering impairment, underscoring the need for ongoing attention to CRCI, which appears to stabilize at 12 months and beyond”, the team concludes.

“In quantifying the unique contribution of chemotherapy to CRCI, our findings underscore the value of precision-guided care in identifying women most likely to benefit from chemotherapy and sparing those who are unlikely to benefit from treatment.” 

Reference 

Wagner LI, Gray RJ, Sparano JA, et al. Patient-reported cognitive impairment among women with early breast cancer randomly assigned to endocrine therapy alone versus chemoendocrine therapy: Results from TAILORx. J Clin Oncol; Advance online publication 9 April 2020. doi: 10.1200/JCO.19.01866