Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute Amsterdam, the Netherlands.
J Clin Oncol. 2010 Mar 10;28(8):1294-300. doi: 10.1200/JCO.2008.21.3553. Epub 2010 Feb 8.
To evaluate the influence of adjuvant tamoxifen and exemestane on cognitive functioning in postmenopausal patients with breast cancer (BC).
Neuropsychological assessments were performed before the start (T1) and after 1 year of adjuvant endocrine treatment (T2) in Dutch postmenopausal patients with BC, who did not receive chemotherapy. Patients participated in the international Tamoxifen and Exemestane Adjuvant Multinational trial, a prospective randomized study investigating tamoxifen versus exemestane as adjuvant therapy for hormone-sensitive BC.
Participants included 80 tamoxifen users (mean age, 68.7 years; range 51 to 84), 99 exemestane users (mean age, 68.3 years; range, 50 to 82), and 120 healthy controls (mean age, 66.2 years; range, 49 to 86). At T2, after adjustment for T1 performance, exemestane users did not perform statistically significantly worse than healthy controls on any cognitive domain. In contrast, tamoxifen users performed statistically significantly worse than healthy controls on verbal memory (P < .01; Cohen's d = .43) and executive functioning (P = .01; Cohen's d = .40), and statistically significantly worse than exemestane users on information processing speed (P = .02; Cohen's d = .36). With respect to visual memory, working memory, verbal fluency, reaction speed, and motor speed, no significant differences between the three groups were found.
After 1 year of adjuvant therapy, tamoxifen use is associated with statistically significant lower functioning in verbal memory and executive functioning, whereas exemestane use is not associated with statistically significant lower cognitive functioning in postmenopausal patients with BC. Our results accentuate the need to include assessments of cognitive effects of adjuvant endocrine treatment in long-term safety studies.
评估辅助他莫昔芬和依西美坦对绝经后乳腺癌（BC）患者认知功能的影响。
荷兰绝经后未接受化疗的 BC 患者接受辅助内分泌治疗前（T1）和治疗 1 年后（T2）进行神经心理学评估。患者参加了国际他莫昔芬和依西美坦辅助多国试验，这是一项前瞻性随机研究，旨在调查他莫昔芬与依西美坦作为激素敏感 BC 的辅助治疗。
参与者包括 80 名他莫昔芬使用者（平均年龄 68.7 岁；范围 51 至 84）、99 名依西美坦使用者（平均年龄 68.3 岁；范围 50 至 82）和 120 名健康对照者（平均年龄 66.2 岁；范围 49 至 86）。在 T2 时，在调整 T1 表现后，依西美坦使用者在任何认知域的表现均未显著差于健康对照者。相比之下，他莫昔芬使用者在言语记忆（P <.01；Cohen's d =.43）和执行功能（P =.01；Cohen's d =.40）方面的表现明显差于健康对照者，并且在信息处理速度方面的表现明显差于依西美坦使用者（P =.02；Cohen's d =.36）。关于视觉记忆、工作记忆、言语流畅性、反应速度和运动速度，三组之间未发现显著差异。
在辅助治疗 1 年后，他莫昔芬的使用与言语记忆和执行功能的统计学上显著下降相关，而依西美坦的使用与绝经后 BC 患者的认知功能统计学上无显著下降相关。我们的结果强调了在长期安全性研究中纳入对辅助内分泌治疗认知影响的评估的必要性。
