Chemobrain: is systemic chemotherapy neurotoxic?

Abstract

Purpose of review: The existence of chemobrain has become almost universally accepted, although many details of the concept are controversial. Data about the different types of cognitive impairment and their duration are not always consistent in the literature. We still do not know which cytotoxic agents are responsible, which characteristics make patients vulnerable, and which biologic mechanisms are involved.

Recent findings: Through this review of the recent literature, we provide an actualized definition of chemobrain including recent functional imaging data and we debate its controversial aspects. Potential causes such as oxidative stress and their potential clinical application in the prevention and treatment of chemobrain are also discussed. Eventually, the methodological aspects of published studies are questioned and propositions are provided in order to improve the design of future trials.

Summary: This issue is of clinical importance given the prevalence of breast carcinoma, the increased use of chemotherapy as adjuvant therapy, the increasing use of more aggressive dosing schedules, and the increasing survival rates. Better designed future trials should lead to a better definition and understanding of chemobrain and to future therapies.