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Effects of tamoxifen and exemestane on cognitive function in postmenopausal patients with breast cancer

BACKGROUND: Cognitive effects of tamoxifen have been described. We augment data from a previous short-term (ST) follow-up study with long-term (LT) data to evaluate ST and LT cognitive effects of tamoxifen followed by exemestane and exemestane in breast cancer patients. METHODS: Patients from the Ta...

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Autores principales: Lee Meeuw Kjoe, Philippe R, Kieffer, Jacobien M, Small, Brent J, Boogerd, Willem, Schilder, Christina M, van der Wall, Elsken, Meershoek-Klein Kranenbarg, Elma, van de Velde, Cornelis J H, Schagen, Sanne B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121337/
https://www.ncbi.nlm.nih.gov/pubmed/37004168
http://dx.doi.org/10.1093/jncics/pkad022
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author Lee Meeuw Kjoe, Philippe R
Kieffer, Jacobien M
Small, Brent J
Boogerd, Willem
Schilder, Christina M
van der Wall, Elsken
Meershoek-Klein Kranenbarg, Elma
van de Velde, Cornelis J H
Schagen, Sanne B
author_facet Lee Meeuw Kjoe, Philippe R
Kieffer, Jacobien M
Small, Brent J
Boogerd, Willem
Schilder, Christina M
van der Wall, Elsken
Meershoek-Klein Kranenbarg, Elma
van de Velde, Cornelis J H
Schagen, Sanne B
author_sort Lee Meeuw Kjoe, Philippe R
collection PubMed
description BACKGROUND: Cognitive effects of tamoxifen have been described. We augment data from a previous short-term (ST) follow-up study with long-term (LT) data to evaluate ST and LT cognitive effects of tamoxifen followed by exemestane and exemestane in breast cancer patients. METHODS: Patients from the Tamoxifen and Exemestane Adjuvant Multinational trial received 5 years exemestane (exemestane group, n = 114) or 2.5 years tamoxifen followed by 2.5 years exemestane (sequential group, n = 92). Neuropsychological performance was assessed pre-endocrine therapy, after 1 year (ST follow-up) and at 5 years (LT follow-up). A control group of healthy participants (n = 120) were assessed with parallel intervals. With random effects modeling we evaluated cognitive changes from baseline to ST and LT follow-up. Statistical tests were 2-sided. RESULTS: After controlling for age, intelligence quotient, attrition, menopausal symptoms, anxiety and/or depression, and/or fatigue, the sequential group showed ST and LT decline compared with control participants on verbal memory (effect size [ES] = 0.26, P = .01; ES = 0.34, P = .003) and executive function (ES = 0.27, P = .007; ES = 0.38, P = .002). Compared with the exemestane group, the sequential group demonstrated ST decline on information processing speed (ES = 0.33, P = .01) and executive function (ES = 0.32, P = .01) and LT decline on verbal memory (ES = 0.33, P = .02). The exemestane group showed no cognitive decline compared with control participants. CONCLUSION: Cognitive adverse effects of tamoxifen alone and after switching to exemestane were observed, suggestive of a carryover effect of tamoxifen. Our results underline the need for well-controlled, prospective trials studying cognitive effects of endocrine therapy.
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spelling pubmed-101213372023-04-22 Effects of tamoxifen and exemestane on cognitive function in postmenopausal patients with breast cancer Lee Meeuw Kjoe, Philippe R Kieffer, Jacobien M Small, Brent J Boogerd, Willem Schilder, Christina M van der Wall, Elsken Meershoek-Klein Kranenbarg, Elma van de Velde, Cornelis J H Schagen, Sanne B JNCI Cancer Spectr Article BACKGROUND: Cognitive effects of tamoxifen have been described. We augment data from a previous short-term (ST) follow-up study with long-term (LT) data to evaluate ST and LT cognitive effects of tamoxifen followed by exemestane and exemestane in breast cancer patients. METHODS: Patients from the Tamoxifen and Exemestane Adjuvant Multinational trial received 5 years exemestane (exemestane group, n = 114) or 2.5 years tamoxifen followed by 2.5 years exemestane (sequential group, n = 92). Neuropsychological performance was assessed pre-endocrine therapy, after 1 year (ST follow-up) and at 5 years (LT follow-up). A control group of healthy participants (n = 120) were assessed with parallel intervals. With random effects modeling we evaluated cognitive changes from baseline to ST and LT follow-up. Statistical tests were 2-sided. RESULTS: After controlling for age, intelligence quotient, attrition, menopausal symptoms, anxiety and/or depression, and/or fatigue, the sequential group showed ST and LT decline compared with control participants on verbal memory (effect size [ES] = 0.26, P = .01; ES = 0.34, P = .003) and executive function (ES = 0.27, P = .007; ES = 0.38, P = .002). Compared with the exemestane group, the sequential group demonstrated ST decline on information processing speed (ES = 0.33, P = .01) and executive function (ES = 0.32, P = .01) and LT decline on verbal memory (ES = 0.33, P = .02). The exemestane group showed no cognitive decline compared with control participants. CONCLUSION: Cognitive adverse effects of tamoxifen alone and after switching to exemestane were observed, suggestive of a carryover effect of tamoxifen. Our results underline the need for well-controlled, prospective trials studying cognitive effects of endocrine therapy. Oxford University Press 2023-04-02 /pmc/articles/PMC10121337/ /pubmed/37004168 http://dx.doi.org/10.1093/jncics/pkad022 Text en © The Author(s) 2023. Published by Oxford University Press. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Article
Lee Meeuw Kjoe, Philippe R
Kieffer, Jacobien M
Small, Brent J
Boogerd, Willem
Schilder, Christina M
van der Wall, Elsken
Meershoek-Klein Kranenbarg, Elma
van de Velde, Cornelis J H
Schagen, Sanne B
Effects of tamoxifen and exemestane on cognitive function in postmenopausal patients with breast cancer
title Effects of tamoxifen and exemestane on cognitive function in postmenopausal patients with breast cancer
title_full Effects of tamoxifen and exemestane on cognitive function in postmenopausal patients with breast cancer
title_fullStr Effects of tamoxifen and exemestane on cognitive function in postmenopausal patients with breast cancer
title_full_unstemmed Effects of tamoxifen and exemestane on cognitive function in postmenopausal patients with breast cancer
title_short Effects of tamoxifen and exemestane on cognitive function in postmenopausal patients with breast cancer
title_sort effects of tamoxifen and exemestane on cognitive function in postmenopausal patients with breast cancer
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121337/
https://www.ncbi.nlm.nih.gov/pubmed/37004168
http://dx.doi.org/10.1093/jncics/pkad022
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