Feasibility of Quantifying the Effects of Epoetin Alfa Therapy on Cognitive Function in Women with Breast Cancer Undergoing Adjuvant or Neoadjuvant Chemotherapy

O’Shaughnessy, Joyce; Vukelja, Svetislava J.; Holmes, Frankie A.; Savin, Michael A.; Jones, Monte; Royall, Donald R.; George, Mercy; Hoff, Daniel D. Von

doi:10.3816/cbc.2005.n.002

Cited by 104 publications

(66 citation statements)

References 31 publications

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“…Studies of pharmacological treatment of cognitive deficits that have been conducted in patients with cancers outside the CNS [77,[94][95][96] suggest that it might be worthwhile to determine the preventive effects of erythropoietin or similar stimulating agents in these patients and in those with brain cancer.…”

Section: Five-year Viewmentioning

confidence: 99%

Interventions for cognitive deficits in patients with a brain tumor: an update

Gehring

Aaronson

Taphoorn

et al. 2010

Expert Review of Anticancer Therapy

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Section: Five-year Viewmentioning

confidence: 99%

Interventions for cognitive deficits in patients with a brain tumor: an update

Gehring

Aaronson

Taphoorn

et al. 2010

Expert Review of Anticancer Therapy

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“…Darbepoetin a is a hyperglycosylated, humanrecombinant erythropoietin, and favorable effects of erythropoietin on cognitive performance during adjuvant chemotherapy have been reported. 22 …”

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confidence: 99%

Cognitive function during neoadjuvant chemotherapy for breast cancer

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Untch

Lux

et al. 2007

Cancer

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BACKGROUND.It is believed widely that chemotherapy‐induced cognitive impairment occurs in a subgroup of patients with breast cancer. However, recent reports have provided no evidence that chemotherapy affects cognition. In this study, the authors questioned whether cognitive compromise in patients with breast cancer is attributable to chemotherapy. In addition, the effects of therapy‐induced menopause and of the erythropoiesis‐stimulating factor darbepoetin α on cognitive performance were assessed.METHODS.A battery of neuropsychological tests was used to assess cognitive performance in 101 patients with breast cancer before neoadjuvant chemotherapy (T1) and toward the end of neoadjuvant chemotherapy (T2) with combined epirubicin, paclitaxel, and cyclophosphamide with concomitant darbepoetin α. Repeated‐measures multiple analyses of variance and a reliable‐change approach were used for statistical analyses.RESULTS.At T1, the group means ranged below the test norms in 5 of 12 cognitive tests. At T2, multiple analyses of variance (MANOVA) indicated a significant overall improvement in the test results (P < .001). After correcting for practice effects, cognitive decline predominated in 27% of patients, whereas improvement predominated in 28% of patients. Cognitive performance was not related significantly to self‐reported cognitive problems, anxiety and depression, menopause, or darbepoetin α administration.CONCLUSIONS.Even before chemotherapy, a subgroup of patients with breast cancer showed cognitive compromise that was unrelated to anxiety or depression. During chemotherapy, cognitive function remained stable in most patients, improved in a subgroup, and deteriorated in another subgroup. The deterioration may have been caused by side effects of chemotherapy, but it also may have been related to currently unidentified factors that cause prechemotherapy cognitive compromise. Therapy‐induced menopause and darbepoetin α did not appear to influence cognition. Cancer 2007. © 2007 American Cancer Society.

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“…14 Two human pilot studies suggest the antiapoptotic effects of rHuEpo may improve clinical outcomes in stroke and in neurocognitve dysfunction associated with chemotherapy. 15,16 Indeed, rHuEpo therapy reduces the neurocognitive dysfunction associated with dialysis, although this effect has historically been attributed to increasing the hematocrit. [17][18][19] We hypothesized that rHuEpo would reduce the incidence of NCD after CABG surgery.…”

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confidence: 99%

The Erythropoietin NeuroProtective Effect: Assessment in CABG Surgery (TENPEAKS)

Haljan

Maitland

Buchan

et al. 2009

Stroke

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Background and Purpose-Neurocognitive dysfunction complicates coronary artery bypass surgery. Erythropoietin may be neuroprotective. We sought to determine whether human recombinant erythropoietin would reduce the incidence of neurocognitive dysfunction after surgery. Methods-We randomly assigned 32 elective first-time coronary artery bypass graft patients to receive placebo or 375 U/kg, 750 U/kg, or 1500 U/kg of recombinant human erythropoietin divided in 3 daily doses, starting the day before surgery. Primary outcomes were feasibility and safety, and secondary outcomes were neurocognitive dysfunction at discharge and 2 months. Results-All subjects were male, mean age 60 years (range 46 to 73). No significant differences were found in pump time, cross-clamp time, or hospital length of stay. Mortality and pure red cell aplasia were not observed. One patient in the 375 U/kg group had ST changes compatible with myocardial injury immediately postoperative, but no other thrombotic complications were observed. Neurocognitive dysfunction occurred in 21/32 (66%) of patients at discharge and 5/32 (16%) at 2 months. Neurocognitive dysfunction at discharge by group was: placebo 6/8 (75%), 375 U/kg 4/8 (50%), 750 U/kg 6/8 (75%), and 1500 U/kg 5/8 (63%). Neurocognitive dysfunction at 2 months by group was: placebo 3/8 (38%), 375 U/kg 1/8 (13%), 750 U/kg 1/8 (13%), and 1500 U/kg 0/8 (0%). Neurocognitive dysfunction at 2 months for erythropoietin at any dose was 2/24 (8.3%) versus 3/8 (38%) for placebo (Pϭ0.085). Conclusions-This

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Feasibility of Quantifying the Effects of Epoetin Alfa Therapy on Cognitive Function in Women with Breast Cancer Undergoing Adjuvant or Neoadjuvant Chemotherapy

Cited by 104 publications

References 31 publications

Interventions for cognitive deficits in patients with a brain tumor: an update

Interventions for cognitive deficits in patients with a brain tumor: an update

Cognitive function during neoadjuvant chemotherapy for breast cancer

The Erythropoietin NeuroProtective Effect: Assessment in CABG Surgery (TENPEAKS)

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