Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA USA; Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA USA; Department of Psychiatry, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA USA.
Lancet Oncol. 2019 Feb;20(2):e92-e102. doi: 10.1016/S1470-2045(18)30938-0.
Cognitive dysfunction is a challenging adverse effect of chemotherapy and radiotherapy that has limited treatment options. Clinical trials for proposed pharmacotherapeutic interventions to help manage these cognitive symptoms have had conflicting results and no standard of care has yet been established. Pharmacotherapeutic approaches for cancer therapy-induced cognitive symptoms include CNS stimulants (eg, methylphenidate and modafinil), medications used in patients with memory impairment (eg, donepezil, memantine, and ginkgo biloba), and bone marrow supporting agents (eg, erythropoietin). Whilst the beneficial effects of CNS stimulants have been mainly reported in children, efficacy in adults has been varied. Antidementia drugs have emerged as promising compounds in the management of cognitive dysfunction, but clinical experience of their use remains limited. Therefore, large clinical trials for these putative memory-enhancing drugs are needed to establish their clinical value in an oncology setting. Several clinical trials testing novel pharmacotherapeutic interventions for the management of cognitive dysfunction are ongoing, as well as numerous preclinical studies. With an increasing understanding of the molecular and cellular mechanisms underlying cognitive deficits in patients with cancer, novel treatment strategies are emerging.
认知功能障碍是化疗和放疗的一种具有挑战性的不良反应，其治疗选择有限。针对这些认知症状的拟议药物治疗干预措施的临床试验结果相互矛盾，尚未建立标准的治疗方法。用于癌症治疗引起的认知症状的药物治疗方法包括中枢神经系统兴奋剂（例如哌醋甲酯和莫达非尼）、用于记忆障碍患者的药物（例如多奈哌齐、美金刚和银杏叶提取物）和骨髓支持剂（例如促红细胞生成素）。虽然中枢神经系统兴奋剂的有益作用主要在儿童中报道，但在成人中的疗效却各不相同。抗痴呆药物已成为治疗认知功能障碍的有希望的化合物，但它们的临床应用经验仍然有限。因此，需要进行大型临床试验来确定这些潜在的增强记忆药物在肿瘤学环境中的临床价值。目前正在进行多项临床试验，以测试用于治疗认知功能障碍的新型药物治疗干预措施，同时还有大量的临床前研究。随着对癌症患者认知缺陷的分子和细胞机制的认识不断加深，新的治疗策略正在出现。
