“Chemo Brain”: Fact or Fiction?

Over the years patients have been informing their doctors that they experience “chemo brain”.  We now have scientific proof that this is a real entity and hopefully this study will encourage further research into prevention and or treatment of this very real phenomenon. This was a difficult area to address as there are so many other conditions that affect cognition during the cancer experience.  Many of the drugs that are prescribed for nausea, pain control and depression can also impact on short term memory. Narcotics affect many cognitive functions and sometimes an adjustment or change to a different class of drug is warranted.  Depression as a single entity impacts on memory and ability to focus which also mimics this condition we know as “chemo brain”. It remains important to discuss with your medical team any changes associated with brain function and do not “chalk it up to chemo brain”.

The following is an article about it published by the National Cancer Institute (NCI):

Chemotherapy Affects Brain Structure of Breast Cancer Patients

A new study has provided some of the strongest direct evidence to date that chemotherapy has physical effects on areas of the brain that, when altered, could result in the array of cognitive symptoms that is often called “chemo brain.” The study was published online August 6 in Breast Cancer Research and Treatment.

In a small study of women with breast cancer, researchers from the Indiana University School of Medicine used MRI scans to show that chemotherapy was associated with a decrease in the density of brain gray matter. The affected areas include those involved in memory and in the ability to process information. Although several other studies have shown similar changes in these areas of the brain, this was the first study to follow women prospectively and to compare scans before and after chemotherapy.

“The alterations in gray matter density observed in the [chemotherapy] group are… consistent with the pattern of cognitive complaints and impairment found in neurocognitive studies,” wrote Dr. Andrew J. Saykin and colleagues.

The study included 17 women with breast cancer who underwent chemotherapy after surgery, 12 women with breast cancer who did not receive chemotherapy after surgery, and a control group of 18 healthy women. The initial MRI scans, performed shortly after surgery in the participants with cancer, showed no notable differences in gray matter density among the three groups. One month after completion of chemotherapy, however, MRI scans revealed notable decreases in gray matter density in women with breast cancer, as well as changes in gray matter density in women who received surgery only, although the changes for these women were not as great. No changes were seen in women in the control group. After 1 year, women treated with chemotherapy had recovered gray matter losses in some regions, but other deficits persisted.

Exactly how chemotherapy may be causing these changes is unclear, said study co-author Dr. Brenna McDonald. “However, the finding that the changes appear to resolve naturally to some degree in the first year after chemotherapy is completed is a very positive one,” she wrote in an e-mail message. Because of the limited follow-up in the study, she continued, it’s unclear how much further recovery may occur naturally. A number of studies have shown that such cognitive effects can persist for many years, she added. Additional studies are investigating whether other therapies, such as tamoxifen, may have similar effects on brain structure.

Response to the posting “Mesothelioma: Finally, a cure called NGR-hTNF?”

Janet I thought that the best way to address this question would be for all of us to look at the abstract and discover what the results of this Phase II Clinical Trial will mean to mesothelioma patients.

This study is promising, but a cure… not yet… A possible new treatment option… maybe. The drug in question holds promise and is an agent that targets the new blood vessels that supply tumors. This trial enrolled 57 mesothelioma patients who had received prior treatment.  This abstract discussed the results of two cohorts of patients who were given this drug on two different schedules. The trial was a Phase II study which means that they knew the safe dose of the drug but the activity was still to be determined.  This new agent was tested against best supportive care which means that patients were randomized to receive comfort measures (i.e. palliative care) and the other group received this drug. This was not a placebo controlled trial but best supportive care which can vary among providers.  The supportive care needs of patients are diverse so I do not think there will be a standard that can be universally applied to a cancer patient population. This drug was reported to be more efficacious than support care measures in 46% of the patients who participated.  In the overall study population (N = 57), median PFS (progression free survival) was 2.8 months. Median progression-free time (stable disease) was 4.7 months in twenty-six patients (46%) who achieved disease control. Median survival was 12.1 months. 54% of the patients did not benefit from NGR-hTNF.

I do suggest that we monitor this drug during its development phase and I would suggest that patients add this to the list of clinical trials that they might consider participation. This trial was small and had two different schedules so if they decide to proceed in testing in mesothelioma they will need to conduct a trial with a large number of mesothelioma patients and all of the subjects treated using the same dose and schedule.I am eagerly awaiting the results of the Vorinostat (Zolinza) trial for 2nd line. Other trials results that are expected during the Spring/Summer would be the trial of Pemetrexed (Alimta)/ Cisplatin and MORAb009 vs Pemetrexed and Cisplatin alone and the large French Intergroup Study looking at the combination of Pemetrexed/Cisplatin/Bevacuzimab(Avastin) vs. {Pemetrexed/Cisplatin alone.

View the abstract here.

~Mary Hesdorffer, NP

Click here to contact Mary Hesdorffer, Nurse Practitioner or call 877.363.6376

Mesothelioma is Everybody’s Problem and we’re working toward the solution

Mesothelioma is Everybody’s problem and the solution requires a global effort. The Mesothelioma Applied Research Foundation holds a key role in promoting global efforts to find a cure.  The latest grant proposals went out to the reviewers last week, so the process has begun.  I hope that with your help we will be able to fund a good percentage of those grants identified by the reviews as worthy of funding.  This is one of the most satisfying aspects of my job, as I monitor this process from start to finish and share with you the vision that a cure is possible if we just continue to work hard and stimulate brilliant minds to focus on mesothlelioma.

~Mary Hesdorffer, NP

Click here to contact Mary Hesdorffer, Nurse Practitioner or call 877.363.6376

Research Funding and the Long Road to Drug Discovery

Here is a very interesting article about the man behind Alimta, the first FDA approved drug for mesothelioma treatment.  “His find became tumors’ nemesis”

This article highlights and confirms our need to continue to grow the Mesothelioma Applied Research Foundation’s Research Grant Program.  Through our proven peer-review process, we are able to identify the best possible projects and disperse funds quickly and efficiently.  Most recently, the fruits of our labor have become increasingly evident, as more clinical trials based on our basic lab funding are becoming available to mesothelioma patients. We are relying on your generous contributions to help us achieve the progress needed to help mesothelioma patients today.  To contribute, please contact our office at (877) 363-6376 (END-MESO) or visit our donation page.

Follow-Up to NY Times’ article on Palliative Care

In the Sunday Times dated April 11th there were some very thought provoking responses to the article we posted last week regarding palliative care.  I think this is an area of great interest to our patient population and I would like to continue the discussion.  I read with great interest the responses from palliative care experts and I am convinced that so many of you would benefit from requesting that palliative care become part of your expert medical team.  Fran Heller a much respected member of NY Presbyterian Hospital/Columbia University will be leading a group as well as meeting with patients and family members who would like expert advice.  There will be many professionals from various disciplines on hand so please take advantage of their expertise.

Letters to the Editor, New York Times, April 10

If you haven’t read our previous blog, take a look here and also make sure to go through the comments sections.