Prospective Evaluation of the Impact of Antiangiogenic Treatment on Cognitive Functions in Metastatic Renal Cancer

Florence Joly (1, 2) , Natacha Heutte (2) , Brigitte Duclos (3) , Sabine Noal (1) , Isabelle Léger-Hardy (4) , Sarah Dauchy (4) , Nadine Longato (3) , Laurence Desrues (5, 6) , Nadine Houédé (7, 8) , Marie Lange (1, 2) , Emmanuel Sevin (1) , Chantal Rieux (1) , Bénédicte Clarisse (1) , Hélène Castel (5, 6) , Bernard Escudier (9)

1 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
2 ANTICIPE - Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers
3 Département d'Oncologie et Hématologie [Strasbourg]
4 DISSPO - Département Interdisciplinaire de Soins de Support aux Patients en Onco-hématologie [Gustave Roussy]
5 DC2N - Différenciation et communication neuronale et neuroendocrine
6 IRIB - Institute for Research and Innovation in Biomedicine
7 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
8 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
9 Oncologie génito-urinaire

BACKGROUND: Little is known about the cognitive effects of antiangiogenic therapies (AATs) in metastatic renal cell carcinoma (mRCC) and their relation with fatigue. OBJECTIVE: To evaluate the impact of AATs on cognition and its connection with fatigue and quality of life (QoL) in patients with mRCC. DESIGN, SETTING, AND PARTICIPANTS: This prospective study enrolled 75 patients starting AAT as first or second line for mRCC and assessed them at 3 mo (n=58) and 6 mo (n=50). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We assessed objective cognitive decline with a neuropsychological battery of tests and cognitive complaint, fatigue, and QoL with validated self-reported questionnaires using the Fisher exact test, Wilcoxon test, and Spearman correlation coefficient. RESULTS AND LIMITATIONS: A decline of cognitive functions was observed in 18 patients (31%) including 13 without cognitive impairment at baseline. The score of fatigue was increased in all patients except one. A relationship between cognitive complaints and fatigue was observed (p<0.05) but not with objective cognitive decline. Cognitive complaints and fatigue had a significant impact on most of the domains of QoL (p<0.01). A positive correlation was found between fatigue and inflammatory markers but not with cognition. The main limitation of this study is the absence of a control group. CONCLUSIONS: AAT induced cognitive decline in patients with mRCC independently of fatigue. These side effects affecting QoL should be better assessed in clinical trials and taken into account in routine practice. PATIENT SUMMARY: Fatigue is a well-known effect of antiangiogenic therapies (AATs) of cancer. The study performed in patients with treated metastatic renal cancer shows a decline of cognitive functions induced by AATs, such as information-processing speed or working memory, in a third of patients, independently of fatigue. Patients on AATs should be informed of these possible adverse effects.

Mots clés: Antiangiogenic therapy; Cognition; Fatigue; Renal cancer

Domaines: Médecine humaine et pathologie

Florence Joly, Natacha Heutte, Brigitte Duclos, Sabine Noal, Isabelle Léger-Hardy, et al.. Prospective Evaluation of the Impact of Antiangiogenic Treatment on Cognitive Functions in Metastatic Renal Cancer. European Urology Focus, 2016, 2 (6), pp.642 - 649. ⟨10.1016/j.euf.2016.04.009⟩. ⟨hal-01893539⟩