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Alert Number 207

Toxicity and "Chemo Brain"

Date: November 30, 2006

As I read this latest article (attached below), I experienced one of those “Duh!” moments.

Just about every cancer patient I have ever known who has been through intensive chemotherapy treatment has felt that there was one specific adverse effect of treatment that is rarely discussed or even acknowledged by oncologists: namely, the infamous “chemo brain”. Fortunately, most of the common CLL drugs seem to cause only temporary chemo brain in the majority of patients. This effect is much more pronounced in patients undergoing therapy for aggressive “solid” cancers. (But I have to admit, cytosine arabinoside cited in the article is sometimes used to treat CLL).

This is the first study that puts chemo brain on a sound scientific footing. No longer can doctors dismiss patients’ experiences of chemo brain as due to their “vulnerable psychological state”. In other words, “It's all in your head, Dear,” type of crappy condescension is no longer acceptable. The effect is real, and it is time our doctors took that into account as they judge the right dosages of drugs to be used, the right balance between risks and rewards.

As the press report below correctly points out, it would be foolish to forgo necessary and life saving therapy for your cancer just because it would mean you may wind up a few neurons short of a full deck as a result. The concept is pretty easy to remember: do what you have to do to live today, so that you can fight another day. The quickest way of killing off all of your neurons is to die of cancer because you refused therapy.

But it also means we have to pay attention to reduced toxicity regimens and hold our researchers responsible to pay serious attention as well. I am a strong believer of the concept “less is more”, when it comes to drug therapy choices. That is why CLL Topics is such fervent supporter of lower impact approaches (such as EGCG, FRC Lite, Low dose Rituxan, non-myeloablative mini-stem cell transplants), and why I am so leery of heavy duty “sledgehammer” approaches using high dose anything. Several links are provided below for your reading pleasure. I hope you browse through these if you are a newcomer to the CLL world. As the Chinese curse is supposed to go, we live in interesting times.

FCR "Lite";
Low Dose Rituxan?;
High Intensity Humax CD20: hypcomplementemia?
Winning The Battle But Losing The War;
Campath + HDMP "Sledgehammer";
FCR plus Mitoxantrone - Over The Top?
Mini-Allo Stem Cell Transplants.

Be well,


News Report:

BBC News

Chemo drugs 'destroy brain cells'

Drugs used to destroy cancer cells may actually be more harmful to healthy cells in the brain, research suggests.

A team from New York's University of Rochester found several types of key brain cell were highly vulnerable to the drugs. They say it might help explain side effects such as seizures and memory loss associated with chemotherapy - collectively dubbed 'chemo brain'. The research is published in the Journal of Biology.

Drug therapy for cancer can prompt a wide range of neurological side effects, even the onset of dementia. But they were thought not to be directly linked to the drug treatment itself.

Instead, some doctors have put them down to the patient's vulnerable psychological state. The latest study found that dose levels typically used when treating patients killed 40% to 80% of cancer cells - but 70% to 100% of human brain cells grown in the lab, and caused serious damage to brain cells when given to mice. Several types of healthy brain cell continued to die for at least six weeks after exposure.

Common drugs tested

Lead researcher Dr Mark Noble said: "This is the first study that puts chemo brain on a sound scientific footing, in terms of neurobiology and cellular biology." The Rochester team carried out tests with three drugs used to treat a wide range of cancers: carmustine, cisplatin and cytosine arabinoside. All three drugs were toxic to several types of brain cell whose job is to repair other cells in the brain - even at very low concentrations. They also killed off oligodenrocyte cells, which play a key role in the transmission of messages around the nervous system. The researchers suggest damage to cells in the hippocampus, which is responsible for memory and learning, is most likely to explain chemo brain symptoms.

Professor John Toy, Cancer Research UK’s medical director, said: "The doses of therapy needed to treat cancer while leaving the body's healthy cells as unharmed as possible is a fine balance judged by experienced specialists. "They aim to maximize benefits and minimize damage. Unfortunately side-effects can include toxicity to the brain.

"This research in mice may hopefully suggest new ways of researching how this toxicity might be overcome. "It is important to remember, however, that all presently available cancer treatments have gone through extensive clinical trials to ensure that their benefits outweigh unwanted effects. "No patient should stop their treatment because of this research."

The researchers said it might be possible to add protective agents to chemotherapy drugs. They also suggest further work to pinpoint which cells are most at risk.

Story from BBC NEWS

Published: 2006/11/30 07:31:21 GMT


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