JNCI Cancer Spectr. 2023 Apr 2:pkad022. doi: 10.1093/jncics/pkad022. Online ahead of print.
ABSTRACT
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). Controls (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 controls 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 controls.
CONCLUSION(S): 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.
PMID:37004168 | DOI:10.1093/jncics/pkad022
