P05.81 Neurocognitive assessment in cancer patients without central nervous system disease treated with bevacizumab at week 34: an observational transversal multi-centric pilot study. (19th September 2018) - Panciroli, C
Abstract: Background: Low performances in visuomotor processing speed and executive functions were found after 34 weeks of treatment with bevacizumab plus radiotherapy (XRT) and temozolomide (TMZ) in first line treated glioblastoma patients but not in patients treated with TMZ and XRT, suggesting that bevacizumab was the cause of those alterations. Our aim was to explore the neurocognitive effects of bevacizumab in non-brain cancer patients in order to assess if the use of this antiangiogenic therapy interfered with the results of the neuropsychological tests. Material and Methods: Seventy-seven cancer patients distributed among four groups were enrolled. None of the subjects suffered from central nervous system (CNS) disorders or had previously diagnosed neurological diseases. The first group (n=20) was treated with bevacizumab and chemotherapy (BEV), the second one (n=19) with chemotherapy alone (ChT), the third group (n=19) received only non-brain radiotherapy (RxT), and the last group (n=19) were healthy people without cancer (HC). Verbal memory, visuomotor scanning speed, executive functions, and verbal fluency were evaluated with the next tests: Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Tests (TMTA, TMTB), Controlled Oral Word Association Test (COWAT). Assessments were administered to each patient after 34 weeks from the treatment's start date (in BEV and ChT groups), or after having completed the radiotherapy sessions (in the RxT group). Results: All patients with cancer (BEV, ChT and RxT) showed significant alterations of the HVLT-R total recall (HVLT-R TR) in front of the HC (p<0.05). Moreover only the RxT showed a lower performance than the HC in the delayed recall (DR) of the HVLT-R (p=0.011). No statistically significant differences were observed in any tests among cancer patients groups. Conclusion: Our results suggest that the use of bevacizumab during 34 weeks does not produce a neurocognitive decline in cancer patients without CNS disease, in front of the group treated with chemotherapy alone. This means that combining bevacizumab with chemotherapy does not impact on neurocognitive performance. The spontaneous recall resulted impaired in all cancer patients' groups, and the words delay recall just in the RxT group, when compared to the HC. These are important outcomes to consider as it seems that that the oncologic disease itself could impair the neuro-cognitive functions, despite the treatment administered. Accordingly, other factors such as anxiety, depression, pain, or stress, could interfere with the neuro-psychological assessment.