Pharmacologic management of cognitive impairment induced by cancer therapy.

Philipp Karschnia, Michael W Parsons, Jorg Dietrich

Journal: The Lancet. Oncology 2020;20(2):e92-e102

PMID: 30723041

Full Text on Elsevier Science View on PubMed

Abstract

Cognitive dysfunction is a challenging adverse effect of chemotherapy and radiotherapy that has limited treatment options. Clinical trials for proposed pharmacotherapeutic interventions to help manage these cognitive symptoms have had conflicting results and no standard of care has yet been established. Pharmacotherapeutic approaches for cancer therapy-induced cognitive symptoms include CNS stimulants (eg, methylphenidate and modafinil), medications used in patients with memory impairment (eg, donepezil, memantine, and ginkgo biloba), and bone marrow supporting agents (eg, erythropoietin). Whilst the beneficial effects of CNS stimulants have been mainly reported in children, efficacy in adults has been varied. Antidementia drugs have emerged as promising compounds in the management of cognitive dysfunction, but clinical experience of their use remains limited. Therefore, large clinical trials for these putative memory-enhancing drugs are needed to establish their clinical value in an oncology setting. Several clinical trials testing novel pharmacotherapeutic interventions for the management of cognitive dysfunction are ongoing, as well as numerous preclinical studies. With an increasing understanding of the molecular and cellular mechanisms underlying cognitive deficits in patients with cancer, novel treatment strategies are emerging.

Address: Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA USA; Department of Neurology, Yale School of Medicine, New Haven, CT, USA.; Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA USA; Department of Psychiatry, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA USA.; Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA USA. Electronic address: [email protected].

DOI: 10.1016/S1470-2045(18)30938-0

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MeSH Terms: Antineoplastic Agents, Central Nervous System Stimulants, Cholinesterase Inhibitors, Cognitive Dysfunction, Donepezil, Erythropoietin, Forecasting, Humans, Methylphenidate, Modafinil, Neoplasms, Radiotherapy